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MONITORING WELL INSTALLATION REPORT <br /> Date: l0 lei 1 f CONSTRUCTION <br /> �--,�'._ <br /> � <br /> I <br /> Premise Address: .3 2,-1dI Cenna.4 1,k lcn-. , Total Depth b 2� <br /> Screen Length (from) S; ' (to) <br /> Well No.: W1W-C( Filter Pack (from) 5T (to) <br /> Bentonite (from) NC1 (to) c/ ! <br /> Inspector: Wyk Ca L- Grout (from) _(to) <br /> Drilling rig type <br /> Permit No. b3b7 I Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: A)M ktamDmd.. .i casing <br /> height <br /> Consultant �inm., <br /> FAA <br /> �,�,.s,�.�.ti7.. <br /> Geologist_ ter /e-t wl wt q _ T <br /> ABOVE-GROUND <br /> COMPLETION CHRL Y-BOX <br /> --- - ------- -- COMP_LEIIou- <br /> SPECIAL PERMIT INFO. Ground Solace 7— <br /> Distance to sewer line grout <br /> Domestic well on site - n ) <br /> If yes, location and, stance - h' <br /> � ft. <br /> �zn. <br /> = q <br /> _ C <br /> SAMPLING slotted = <br /> sec on = <br /> Holding Temperature 9 Pack <br /> Method <br /> Screening Method = <br /> Tracking Sheet - y n) K" — <br /> SPOILS <br /> Storage Method SS�! c.� 7�n nM MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( n ) <br /> Storage Location Casing type a �t/C <br /> Blank-----LY— ft. Screen 5- ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios na 9 3:j t,, n c4 _,C Filter Pack type/size zriz <br /> Installation Method U Surge Block: - (y/M <br /> Quantity Installed Discussed with geojoogist: - (y/0 <br /> Type of method <br /> EH 29 29 <br />