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Sr.,0ITORING WELL.INSTALLATION REPORT <br /> Date: I 5 +ZbA5, CONSTRUCTION <br /> Premise Address: z s- ��b Total Depth <br /> p P'�C C°�5 � '�' Screen Length (from) (to) <br /> Well No.: �t ^^'� Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: k4ntil Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. /oI.D. ff MY <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:T_� L <br /> Driller: ca s f ng <br /> r he_ght <br /> ,' —aw, <br /> Consultant C1 <br /> GeoIogist �' --� <br /> AEF0Y -GF{CVN0 CHRWY-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Graurr4 surface <br /> E <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) tt. <br /> If yes, location and distance - IL <br /> 10 <br /> 2- <br /> "ZM <br /> SAMPLING /�c 'T V" - slohad <br /> p sedcn <br /> Holding Temperature ° vW <br /> Method P <br /> Screening Method _ <br /> Tracking Sheet - (y/n ) :` = <br /> SPOILS <br /> Storage Method MATERIALSMEVELOPMENT <br /> Contamination Storage Location Noted - {y/ n) Casing type -2-11 <br /> pUU <br /> Blank ft. Screen ft. <br /> Slot size -07-6 <br /> GROUTING Bags cement <br /> j Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size ?F-2,- <br /> Installation <br /> ZInstallation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />