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MONITORING WELL INSTALLATION REPORT <br /> Date: L I tt IOr{, CONSTRUCTION <br /> Premise Address:_ 2 (9!&o ::InA V,. "AA Total Depth q 0 <br /> Screen Length (from) Toms— (to) ^gyp <br /> Well No.: _LAJ Filter Pack (from) g3 (to) � <br /> Bentonite (from) (to) <br /> Inspector: 1::) out <br /> t I.rp, 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: tie U V <br /> Driller:__ no casing <br /> height <br /> Consultant A-T C_ <br /> i T <br /> Geologist .) (,un „n�wn '.T <br /> ABOVE-GROUND <br /> COMPLETION C-SiM-80X <br /> SPECIAL PERMIT INFO. Groundy COMPLETION g�}x <br /> Distance to sewer line / gra <br /> Domestic well onr'-(y/n) -&I <br /> ft <br /> If yes, locati and distance - 193 <br /> ft <br /> O <br /> SAMPLING = n <br /> Hotrod ::i — c <br /> toc4on <br /> Holding Temperature :. _ P <br /> Method — <br /> ack <br /> Screening Method <br /> Tracking Sheet - (y/n) s' — <br /> 90 n. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - <br /> Storage Location ca,4th Casing type Z <br /> Blank ft. Screen----5—ft. <br /> Slot size . o to <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel_N� <br /> Mix Ratios Filter Pack type/size 'L <br /> Installation Method Surge Block: - (y/ ) <br /> Quantity Installed Discussed with geologist: - (y <br /> Type of method <br /> EH 29 29 <br /> H <br /> H, <br />