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MONITORING WELL INSTALLATION REPt�,,, ' <br /> Date:� A C/ CONSTRUCTION <br /> Premise Address: /fY. rZtJl Total Depth 30 <br /> Screen Length (from) f-SO (to) <br /> Well No.: E 5 Filter Pack (from) ao (to)—T— <br /> Bentonite (from) (to) <br /> Inspector Grout (from <br /> .D ) (to) cJ <br /> Drilling rig type ` <br /> Permit No. � Auger O . r� LD, 3 <br /> Drilling Company:. <br /> Completion - Stove pipe/christie box (circle one) <br /> �,G _ ``�� <br /> Driller: � 7 height <br /> Consultant �3(`� � <br /> Geologist Mr r <br /> ABOVE-GACUND CtiA151Y 80X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT TNFO. Ground SuAaa <br /> Distance to sewer line Of01t I <br /> Domestic well on site - (y/n 5Sfte 5 <br /> If yes, location and distance $ tj <br /> N,. <br /> 0 <br /> SAMPLING = 3 <br /> Holding Te erature <br /> Method L5 - <br /> Screening Method bVW- <br /> Tracking Sheet -0�/ n ) <br /> SPOILS a9 I36 Z 13 0 <br /> Storage Method r3-- ewe– MATE) DEVELOPMENT <br /> Contamination Noted' / a <br /> Storage Locatio t, Casing type 4V� <br /> Blank�ft. Screen ),b ft. <br /> Slot size O <br /> GROUTING Bags cement <br /> Buckets bentonite 0 <br /> Depth to water 7 Bags sand/gravel D <br /> Mix Ratios Cpm Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ <br /> Quantity Installed Discussed with geologist: - (F/ n ) <br /> Type of method <br /> EH 29 29 o v^ <br /> C,C'�(„ <br />