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MONITORING WELL.INSTALLATION REPORT <br /> Date: t { e l CONSTRUCTION <br /> Premise Address: 0 3 5 Par a Total Depth. <br /> P <br /> c /1rJ r <br /> Screen Length (from) <br /> Well No.: t..l -��� <br /> Filter Pack (from) D %L (to)TI �T <br /> Bentonite (from) Oti[- <br /> Inspector. �dd C . Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:��c�� <br /> caing <br /> Driller: &n `� height —qV-F <br /> Consultant [•2b� I 7FMI --r-let <br /> Geologist �2('0!d ABOV&GAcUND <br /> CNRISTY-30X <br /> C OkVL`TKDN CCt,1PLETICN <br /> SPECIAL PERMIT INFO. Ground S z1r+ <br /> 9roul <br /> Distance to sew�IinDomesticwello (y/ n )If yes, locatio nce - n• <br /> o R. <br /> = o <br /> = c <br /> o <br /> iloro i <br /> SAMPLING = $ <br /> sacicn <br /> Holding Temperature _ = LT1°dam <br /> Method <br /> Screening Method tl'1� 7 <br /> Tracking Shcet n ) _ <br /> y S, n• _ n. <br /> SPOILS <br /> Storage Method ,r.s i a1-9 01 � MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n <br /> Storage Location r-- c-� Casing type a VC <br /> Blank 3 D ft Screen 1 J ft. <br /> Slot size o 2 0 — <br /> GROUTING Bags cement ":� — <br /> Buckets bentonite <br /> Bags s <br /> Depth to water n/ 46 _ Ba g sand/ ave� l i <br /> Mix Ratios ', '-J3� _ l z 0 Filter Pack type/size A <br /> Installation Method Surge Block: - (y tt <br /> Quantity installed -3-0 Discussed with geologist: . ( Y n� <br /> Type of method <br /> EH 29 29 <br />