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MONITORING WELL INSTALLATION REP(,,,4 <br /> Date: ' CONSTRUCTION <br /> Premise Address: i q CKD Total Depth vi 5 <br /> W Screen Length (from) . 9,13 -CEO) <br /> Well No. _ `I „ - _. Filter Pack (from) 955 (to) <br /> Bentonite (from) �� (to) <br /> Inspectors Grout (from) (to)_ L <br /> Drilling rig type _ i <br /> Permit No. Auger O.D. Sr �Z_ I.D. 25. 5 <br /> Completion - Stove pipe/ sue boy (circle one) <br /> Drilling Company- <br /> { <br /> Driller: �Db'�'S''•$' casing <br /> • � height <br /> Consultant L �(1 S�.VV�[ <br /> Geologist. <br /> ABOVE-GRCUND CHAISTY-SOX <br /> COWLET(CN COMALFTICN <br /> SPECIAL PERMIT INFO. G=nd Swfaca <br /> i Distance to sewer line grout <br /> Domestic well on site - (y/ n} it. <br /> If yes, location and distance - <br /> �ft. ft. <br /> AZ _ <br /> vh <br /> SAMPLING slarad <br /> Q <br /> &*ellen — <br /> Holding Temperature <br /> ack <br /> Method r L = �"�F <br /> Screening Method (DV M <br /> Tracking Sheet - (y/ n } ::S <br /> ct5ft. .____... 9 <br /> SPOILS <br /> Storage Method U YUm' MATERIALS/DEVELOPMENT <br /> Contamination Noted - (—yy n ) <br /> Storage Location Prn� 1- <br /> r� (SVG <br /> g J.l� Casing type <br /> Blank ft. Screen Dft. <br /> Slot size OZb <br /> GROUTING Bags cement <br /> l Buckets bentonite 5 bOc <br /> Depth to water �d Bags sand/graveI <br /> Mix Ratios SU, mi% to 6004 Filter Pack type/size <br /> Installation Method ' � � Surge Block: - (y/ i <br /> Quantity Installed Discussed with geologist: - (yJ9 <br /> Type of method <br /> EH 29 29 <br />