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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: V3 Go 17ac.,2jn�- CA Total Depth ITO� <br /> Screen Length (from) (to) o <br /> Well No.: 1'V\ li.) - 1 M W Z Filter Pack (from) (to) <br /> Bentonite (from) (to) 4C <br /> Inspector. L AAA _ Grout (from) -� (to) y ' <br /> Drilling rig type <br /> Permit No. Auger O.D. Sc ly I.D. <br /> Completion - Stove pipe/ a bo (circle one) <br /> Drilling Company: �,j-4-J�� i 'AAA <br /> Driller. rLr�f1-�n�l ��►�r f casing <br /> height <br /> Consultant — `q <br /> Geologist <br /> AZ 0V -GRCUND <br /> cowLzrCN -30X <br /> coMPLrmcN <br /> SPECIAL PERMIT INFO. pend Suiacs <br /> Distance to sewer line grout <br /> Domestic well on site - (y- } — :,-ft. <br /> If yes, location and kiS'Cance - <br /> ft. ft. <br /> _ <br /> SAMPLING — o <br /> tloroi =_ � <br /> teckn <br /> Holding Temperature <br /> Method b"6i"'p-> _ _ gmyw Pack <br /> Screening Method <br /> Tracking Shcet - (Y n ) <br /> .Y <br /> f W N <br /> 1 . <br /> SPOILS ---- pp <br /> Storage Method S S" 1�"� ic- MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y n <br /> Storage Location + ACCTA A t /vv c Casing type �)C <br /> Blank s L ft- Screen ac) ft. <br /> Slot size . 0-4-6 <br /> GROUTING Bags cement <br /> Buckets bentonite .r <br /> Depth to water N SSS -.60� Bags sand/gravel r <br /> Mix Ratios Filter Pack type/size <br /> Installation Method I :L&MWddA Surge Block: - ti ) <br /> Quantity Installed 1 zD Discussed with geologist: <br /> EH 29 29 Type of method <br />