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MONITORING WELL INSTALLATION REPORT <br /> Date:_ 02�- - CONSTRUCTION <br /> Premise Address:- 2:,5-C>o Total Depth 2i72'1 <br /> Sween Length (from) <br /> WeII No.: - Filter Pack (from) �__(to ' <br /> Inspector. Bentonite (from)_- ` (to)_____(��____ <br /> Grout (from) <br /> r Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> 0 2-2.5 Completion - Stove pipe/christie box (circle one) <br /> Driller: ^� caging <br /> he_ght <br /> Consultant sr,+-• t <br /> Geologist <br /> 1180VE�RCl1ND <br /> CO MPLFrZ N CNRLM-80X <br /> SPECIAL PERMIT INFO. CCMPt.,ncN <br /> Qrour+d S�siact <br /> Distance to sewer line preut <br /> Domestic well on site - ( y/ n) <br /> If yes, Iocation and distance - A— ft. <br /> tt. - <br /> O <br /> SAMPLING — o <br /> tocicn <br /> Holding Temperature :N <br /> Method , ` ��Fack <br /> Screening Method =_= <br /> ; <br /> Tracking Shcet n ) ir-: <br /> ft. "� = IP Z.Z tt. <br /> SPOILS <br /> Storage Method MATERIALS&EVELOPMENT <br /> Contamination Noted - ) <br /> Storage Location Casing type2- P V _ <br /> Blank ft. Screen.._ 15` ft. <br /> Slot size <br /> GROUTING Bags cement <br /> t Buckets bentonite I <br /> Depth to ivater N Bags sand/gravel -- 15- <br /> Mix <br /> Mix Ratios Filter Pack type/size_- Z 1'Z- 5 C <br /> Installation Method Surge Block: - (y"I <br /> Quantity Installed Discussed with georo-gist: - (y/G) <br /> EH 29 29 Type of method <br />