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v <br /> MONITORING WELL INSTALLATION REPORT" <br /> Dale: I d 2 CONSTRUCTION <br /> Premise Address,,::A ng1'e2� //fyit Total Depth �9� 6V <br /> Well No.: vvl G!/ � li� Screen Length (from) (to) <br /> Filter Pack (from) O (to) �f <br /> Bentonite (from)--- / —(to) <br /> 9-✓', y <br /> Inspector: �� � . Grout (from) (to)S� <br /> ���� Drilling rig type <br /> Permit No._�� Auger O.D. Y " I.D. <br /> Drilling Company: <br /> Completion - Stove pip trtsuc (circle one) <br /> �/a<-��y�,� <br /> Driller: cas Lng <br /> f:2--f -:Fheight <br /> Consultant 14-6 V <br /> / �� �o <br /> Geologist /L �h^ Ci ` <br /> ABOVE-GRCJJND Ct�R15TY30X <br /> COMPLETION COMPL-ETICN <br /> SPECIAL PERMIT INFO. Ground Surtan <br /> Distance to sewer line grout y <br /> Domestic well on site - (y/ n ) �+ ft. <br /> If yes, location and distance - ft. <br /> h. <br /> N <br /> q <br /> _ O <br /> SAMPLING slotad <br /> sor'cn <br /> Holding Temperature = vN <br /> Method <br /> Screening Method /�1V <br /> Tracking Sheet - (y/ n ) _ <br /> 6f <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y p <br /> Storage Location Casing type Se G'L( laL� <br /> Blank _ft. Screen 9 o ft. <br /> Slot size 006 <br /> GROUTING Bags cement <br /> Buckets bentonite 1 <br /> Depth to water Z JrS Bags sand/gravel <br /> Mix Ratios _ Filter Pack type/size <br /> Installation Method Surge Block: - ( y/42 ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />