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MONITORING WELL INSTALL-%TION REPORT ' <br /> t <br /> r .. <br /> Date: CONSTRUCTION <br /> Precose Address : <0 (� A� ' � dZ4�C� Total Depth �� 1 <br /> Screen Lengmh (from) 59 (to) <br /> Well No.: V/aJ D 430 Filter Pack (from) 51 (to) 2� <br /> Bentonite (from) Z$ (to) Z6 <br /> Inspector: "P+� ^-�– Grout (from) 2(a (to) O <br /> Drilling rig type Cnlit 45 <br /> Permit No. 9Z a � 33 Auger O.D . £s /a I.D . 3° <br /> Completion - Stove pipe/chrisde box (circle one) <br /> Drilling Company* <br /> ♦ casing <br /> DrillerG �� I height <br /> A <br /> Consultant E "RNDGrologst i <br /> CtiAISTY3CX ' <br /> COWLc'T10N C.^.{r1PL�l 1 <br /> Ground Surfx& <br /> SPECi .,�I. PERMIT INFO. <br /> grout <br /> Distance to sewer line N/ <br /> Domestic well on site - ( y 6n) <br /> If yes location and distanceZS ft <br /> ME <br /> C <br /> 0 <br /> &lotted — c <br /> SAMPLING on " <br /> gnvlw <br /> Holding Temperature_ _ <br /> Method <br /> Screening Method D tf M :W <br /> Tracking Sheet - � n ) <br /> SPOILS / <br /> Storage Method 6 )t ,F tti ' t V441 MATERIALS/DEVELOPMENT <br /> 0 <br /> Contamination Noted - n ) nz)0e r' a 3dt yTT� rt PVC <br /> Storage Location By oc , e Casing type <br /> Blank Lq ft. Screen <br /> Slot size I <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water /f�� Bags sand/gravel <br /> Mix Ratios �{6 — 30 �a P f F1ter Pack type/size <br /> Installation Method AA � Surge Block: - ( y / n ) <br /> Quandty Installed Discussed with geologist: • ( y / n ) <br /> Type of method <br /> a / <br />