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MONITORING WELL INSTALLATION REPORT Irl <br /> Date: S/�/� 1 CONSTRUCTION <br /> Premise Address: 7&31 11� CA� <br /> I S[ Total Dcpth <br /> Screen Length (from) <br /> Filter Pack <br /> Well No.:__56�i. (to) <br /> (from) (to) <br /> Bentonite (from (to) <br /> Inspector �� Grout (fro (to) <br /> Permit No. <br /> S&00.3 7 1 G Drilling rig We crt/ <br /> Auger O.D._ g I.D. Lp <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: Z�OStpAk <br /> Driller: c a s i ng <br /> Consultant 7F height'9 + <br /> Geologist be r + <br /> ABOVE-GBCUND <br /> CO WL ETiON OMSN-BOX <br /> SPECIAL PERMIT INFO. Gra;nd gLr{xy CG�',4�L_-==N <br /> Distance to sewer line >S0 grout <br /> Domestic well on site - (y n <br /> If yes, location and distance - ft. <br /> • ft. <br /> h. <br /> - — o <br /> SAMPLING ■larod S — <br /> �p� sacicn r <br /> Holding Temperature Y L <br /> Method /L a" I ¢'1"tPOCK <br /> Screening Method r <br /> Tracking Sheet <br /> ft. <br /> SPOILS nn // <br /> Storage Method ��✓✓Lv 1; MATEMAI.S/DEVELOPMENi' <br /> Contamination Noted - (q n <br /> Storage Location A-n stb Casing type <br /> Blank ft Screenft. <br /> Slot size <br /> GROUTING Bags cement <br /> Bu( c" <br /> bentonite <br /> 77-4LDepth to water 'D IIzgs sand/gravcl <br /> Mik Ratios Filter Pack type/ ze <br /> 4psWIadon Method eemu��— Surge Block: - /n ) <br /> QuantityInstalled N.`trn g Discussed vri geologist. - (y/ n ) <br /> Type of nctl d _— <br /> EH 29 29. . <br />