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MONITORING WELL INSTALLATION REPORT <br /> Date: 10 CONSTRUCTION <br /> Premise Address: fn [J„ ,I Total Depth (` L ]JO, 'T (i f eu <br /> e Screen Length (from) Z r6- (to) <br /> Well No.: tM W U6 Screen <br /> Pack (from) 7_H (to) <br /> Bentonite (from) -7 `1 (to) <br /> Inspector: Gk AA A CIL, Grout (from) (to). <br /> / Drilling rig type <br /> Permit No, b S t' S Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:_ (.,, � <br /> Driller:_ !�t2 eA 41\ casing <br /> height <br /> Consultant_ C PLA T <br /> Geologist �ti.p� �� � Q t ;n s _ T <br /> —� ABOVE-GROUND <br /> COMPLETION CHRIM-BOX <br /> SPECIAL PERMIT INFO. Gmund gu{ycy COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on s' - (y/ n ) 7 a yn <br /> If yes, location distance - <br /> a. n. <br /> — o <br /> _ m <br /> SAMPLING = s <br /> slotted = 8c <br /> aocion — <br /> Holding Temperature ajA I <br /> Method I.,'` nn(n 4, - __a b-• _ G""°a�xk <br /> Screening Method et Z <br /> Tracking Sheet -'/ n) <br /> `' ' <br /> SPOILS <br /> Storage Method v MATERIALS/DEVELOPMENT <br /> Contamination Noted - n ) <br /> Storage Location Casing type Y PVC, <br /> Blank 9 eft. Screen <br /> Slot size , az,0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water _A/Zi Bags sand/gravel <br /> Mix Ratios AJ Y 2 .X z® Filter Pack type/size Z I z <br /> Installation Method pz4AA Surge Block: - n ) <br /> Quantity Installed 1- Discussed with geologist: - (y <br /> (i?y <br /> EH 29 29 Type of method L_ftj VA T <br />