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MONITORING WELL INSTALLATION REPOn f <br /> Date: D Ob / Zfo D /028 6 CONSTRUCTION <br /> Ain <br /> Premise Address: z/OMe CA-4 th Total Dep <br /> ZD /+ �2eww�✓C � Screen Length (from) g> (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) 5 <br /> Inspector: Grout (from) (to) O <br /> o ���� Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling <br /> Company <br /> Driller: G(4k'OL-e&r ����-� �KGw�d casing <br /> / height <br /> Consultant (/r _ <br /> Geologist <br /> A8;Y -WtOUND s CliAiMZOX <br /> CONFLECICN /� COMPLETION <br /> SPECIAL PERMIT INFO. nn nd surt , <br /> Distance to sewer line r«rt �" <br /> Domestic well on site - (yCP <br /> If yes, location and distance - -7 <br /> 7ft. <br /> = m <br /> — o <br /> — c <br /> — o <br /> SAMPLING Blood = B <br /> &*Mon <br /> Holding Temperature <br /> Method <br /> r <br /> Screening Method <br /> Tracking Sheet - n ) <br /> ft. <br /> SPOILS 4 Z <br /> i <br /> Storage Method J�5 v MATERIALS/9EVELOPMENT <br /> Contamination Noted - (y 5&.11 cc O-'r 1.61 <br /> Storage Location c dbt Casing type fJ,� <br /> Blank ft. Screen__---------ft. <br /> Slot size •e/D fo C. YT' /A Old <br /> GROUTING Bags cement S4 7 �C <br /> Buckets bentonite it 7K a AcscAG-O <br /> Depth to water ' Bags sand/gravel <br /> Mix Ratios %m I/ Filter Pack type/size <br /> Installation Method U,Aowk ee Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> c SD G!� - 23 OLln Type of method <br /> EH 29 29 pre Cr <br />