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MONITORING WELL INSTALLATION REPORT <br /> Date: 1 a. L 1 1 S CONSTRUCTION <br /> Premise Address: :In cz,ta_ 'A _ _ Total Depth <br /> Screen Length (from) 5 (to)�4 <br /> Well No.: 4\ lA) --- - Filter Pack (from) (to)__L51 <br /> Bentonite (from) 1 ` (to) <br /> Inspector. 1_' A,,f-Ca J. T Grout (from) (to) y t <br /> Drilling rig type <br /> Permit No. (`? (�� Auger O.D. ,2-; I.D. <br /> Completion - Stove pipe/ iri tie box circle one) <br /> Drilling Company: --N <br /> Driller• T <br /> casing <br /> _ height <br /> Consultant »�_,,,G� -��n- <br /> Geologist 'r <br /> A80YE-GAC4JND C S*TY_80X <br /> CaMRLETION COMPLETION <br /> SPECIAL PERMIT INFO. G=nd grlacs <br /> Distance to sewer linegrout <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance <br /> _ o <br /> r <br /> r; o <br /> SAMPLING — s <br /> dorm — <br /> socycn <br /> Holding Temperature <br /> Method A,, x = gavePack <br /> Screening Method „k <br /> Tracking Sheet ) <br /> V n 71' <br /> ft. <br /> Co ft. <br /> SPOILS <br /> Storage Method MATERIALS EVEI.OPMENT <br /> Contamination Noted - ((y n ) <br /> Storage Location Casing type QVC �L2� <br /> Blank_____._L-5- ft. Screen h, <br /> GROUTING Slot size, c,-.�_O <br /> Bags cement <br /> Depth to water115 <br /> Buckets bentonite <br /> Bags sand/gravel� <br /> Mix Ratios G� 4 Filter Pack type/size <br /> Installation Method Surge Block: - (y/M <br /> Quantity Installed .v c� Discussed with geologist: - / n) <br /> EH 29 29 <br /> Type of method <br />