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MONITORING WELL INSTALLATION REPOr[i <br /> Date: CONSTRUCTION <br /> Premise Address:Z( (.-.44 SGC Total Depth O� o v»✓ �� <br /> f� Screen Length (from '/L(to) b <br /> Well No.: Filter Pack (from) io' (to) <br /> Bentonite (from) �' (to) <br /> Inspector: �w Grout (from} <br /> / Drilling rig type <br /> Permit No.—f3 - 1696 6 Auger O.D. 10I.D. <br /> Completion - Stove pipe/clu-istie box (circle one) <br /> Drilling Co any-. 'L/ <br /> Driller: Casing <br /> Consult w T height <br /> Geologist <br /> ABOVE-GROUND CiiFi1STY-BOX <br /> COMPt.ET�ON COMPt,ET[ON <br /> SPECIAL PERMIT INFO. Ground gudace <br /> r � <br /> Distance to sewer Ime f Aran <br /> Domestic well on site - (y <br /> If yes, location and distance - it. <br /> 45:._tt. <br /> 9^ M <br /> SAMPLING s <br /> soden <br /> Holding Te peratur <br /> Method ' -`= gn Pack <br /> 41 >. <br /> Screening Method IM- <br /> Tracking Sheet <br /> aZ:.....�ft. tL <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - n ) e/r, <br /> Storage Location Casing type �" � <br /> Blank 5-1,1 la ft. Screen t5S' ft. <br /> Slot size .dZo r <br /> GROUTING Bags cement <br /> Buckets bentonite l s-• <br /> Depth to water Bags sand/gravel_,?�2 ' (C' <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y 109 <br /> Quantity Installed F Discussed with geo ogist: -C/ n) <br /> Type of method <br /> EH 29 29 <br />