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MONITORING WELL INSTALLATION REPORT <br /> 40e.-(- <br /> Date: <br /> 0e.tDate: CONSTRUCTION <br /> Premise Address: �(9�S !� Total Depth 2 S <br /> Screen Length (from) 2� (to) Z <br /> Well No.: �s-2 Filter Pack, (from) /fl (to) ZS <br /> Bentonite (from) (to) <br /> Inspector: ,//�� Grout (from) (to) <br /> 5� DOS fs7 Drilling rig type_ S.Q <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company. <br /> �S Completion- Stove pipe/christie box (circle one) <br /> Driller: CVGd'�5>! casing <br /> height <br /> Consultant / G T <br /> Geologist <br /> ABOVE-GROUND CNA35'TY-80X <br /> COWPLEfION <br /> COMPLETION <br /> SPECIAL PERMIT INFO. pend Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n} <br /> If yes, location and distance- ft. <br /> ft. <br /> c- of-e up ti.Z A'V i� A03&e Pvl/ ^4 <br /> SAMPLING kiF/,ri, ✓Sym e-,es,`J c . . N` 1f /u�.f(lotte�d = c <br /> *ell �/�y��k-.1.%d� �-L`1'KJ ��d ate/`- isc7on �;'••' <br /> Holding Temperature ' .t'tfc�6OAVp' _ <br /> l•' <br /> Method r2i 5 acrd wj a� _l-,�i�'`'�� ��i re.�ill �.zs� _ 9 P <br /> ack <br /> Screening Method f-/I{�s t., ui.rSY &��i.-Q to ito <br /> Tracking Sheet - (y/n)-_ t�.�s�•�� <br /> ti Sd g4 kA4,-, 9 '5V_kr L/NI <br /> SPOILS ✓/S jdfl'►C n�a�i 1nvY-�r AW, <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y{n} <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size • OZo <br /> GROUTING Bags cement <br /> Buckets bentonite PL(Ic r' hGo b�f H <br /> Depth to water Bags sand/gravel Z7oK'/tvcV 3 ; <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/n) <br /> Quantity Installed Discussed with geologist: - (y/n) <br /> Type of method <br /> EH 29 29 <br />