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MONITORING WELL INSTALLATION REPORT <br /> Date: 2 CONSTRUCTION <br /> Premise Address: i Aga�4— Total Depth oZ <br /> Screen Length (from) l Z' (to) A:4 <br /> Well No.: Filter Pack (from) (to) a t <br /> Bentonite (from) (to) <br /> Inspector: 11 LA11r,21 3 Grout (from) _(to) <br /> Drilling rig type <br /> Permit No. n Auger O.D., 1;) - I.D. <br /> Completion- Stave pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller. - casing <br /> height <br /> Consultant, (n— r r 7 <br /> Geologist yh.'Ju A) ^w\-A' <br /> A8CVc--GFFt0UN0 C qR* Y-8CX <br /> CC1vFLEr#0N CCMPL EnCN <br /> SPECIAL PULNET INFO. CO"`-4 Swf"'' <br /> gf«n <br /> Distance to sewer line <br /> Domestic well on site - (y/ a ) T �•S fL <br /> If yes, location and distance - - tt <br /> a <br /> SAMPLING slanad ~' <br /> sOrcn - <br /> Holding Te erature __ Qm��Pack <br /> Method _ — <br /> Screening Me <br /> Trackin eet - {y/ a) <br /> SPOILS <br /> Storage Method mc, Q 14"')k— — MATERIALSEVELOPMENT <br /> Contamination Noted - (y/ n) <br /> Storage Location Casing type v <br /> ` d � <br /> Blank i— f[. Screen ft <br /> Slot size .o <br /> GROUTING Bags cement L 1LoY- <br /> Buckets bentonite 5 <br /> Depth to water Bags san grave"T <br /> l+( b <br /> Mix Ratios_ Filter Pack typesize <br /> —T�r Surge Block: - (Y <br /> Installation Method - Discussed with geologist: - (y <br /> Quantity Installed Type of method <br /> EH 29 29 <br />