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.viONITORING WELL INSTALLATION REPOR . <br /> Date : 5 l I s ( CONSTRUCTION <br /> t <br /> Premise Address : S` stGutiow� Total Depth -( <br /> l Screen Length (from) ZS' (to) Z <br /> Well No. : - �i 1 � Ll �1 FIlter Pack (from) Z6.r- (to) Z z <br /> 1 _ Bentonite (from) ZZ (to) 10 <br /> Inspector: � tea. w Grout (from) l'j- (to) D <br /> r / Drilling rig type Lcw A rS /1 ctJA� <br /> Permit No, l l Auger O.D. <br /> 5-�' Completion - Stove pipe/c 'e box circle on <br /> Drilling Company: Rj <br /> Driller: V\ O ^Y(. a 03 casing <br /> nnA T height <br /> Consultant / ylJ'� ;�x <br /> Geologist Hca V " <br /> ABOVE-GROUND <br /> COMPLETION x <br /> SPECIAL PERMIT INFO. GroUnd gu�l COMPLETION� <br /> Distance to sewer line grout <br /> Domestic well on site - ( y / n ) <br /> If yes, location and distance - 11 It <br /> ft. Z z It. <br /> — a <br /> SAMPLING <br /> 0 <br /> �Iottad _ � <br /> tx5on <br /> Holding Tempera <br /> Method = g ' pack <br /> Screening I <br /> Tracking S eet - ( y / n ) _ <br /> S = <br /> Z J <br /> z <br /> SPOILS S 61SSlau ✓�wVdw ( vim t <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination ted - ( y / n ) <br /> Storage Locati n Casing type 56' k�V <br /> Blank 7, ft. Screen Z: ft. <br /> Slot size <br /> GROUTING Bags cement_ (i ",*Z- <br /> Buckets bentonite_ <br /> Depth to water l 1 �^ Sy Bags sand/gravel 3 <br /> Mix Ratios S huptrx dr Lbs (-v 'I,owlFilter Pack type/size <br /> Installation Method___AorA � Surge Block: - ( y /„n7 <br /> Quantity Installed i J & Vak Discussed with geologist: - ( y / n ) <br /> Type of method <br /> EH 29 29 <br />