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MONITORING WELL INSTALLATION REPORT <br /> Date: C�31 16 - 6It f 6 CONSTRUCTION <br /> Premise Address: Total Depth ('J�' 50 <br /> Screen Length (from) -315- 75-(to) <br /> Well No.:_y�GJ� kiM ) yy r� �/ Filter Pack (from)3q-36 (to) ;tg'IL-5 <br /> Bentonite (from) a4s-31 (to) ': Y <br /> Inspector: L'�AAANr-� Grout (from) _(to) 7R-31 <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:_(�y�nnn <br /> Driller: casing <br /> height <br /> Consultant 0-,A V\h ��,,,� <br /> Geologist �o CO 'IOtiAi;,k <br /> ABOVE•GRCUND <br /> COMPLETION CHRISTY4= <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sutacs <br /> Distance to sewer line grout <br /> Domestic well on site • / n ) ft <br /> If yes, location istance - <br /> ft. <br /> ft. <br /> = m <br /> — o <br /> = m <br /> — c <br /> SAMPLING slotted = S <br /> sac�on — <br /> Holding Temperature <br /> Method — g'�pack <br /> Screening Method ;r <br /> Tracking Sheet • ( y/ n ) — <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type L N P✓-!-- <br /> Blank L� ft. Screen Flo h, <br /> Slot size )0 ZO <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water ry 4,0 Bags sand/gravel <br /> Mix Ratios 6 Filter Pack type/size &! 3 5-"^DA <br /> Installation Method Surge Block: - ( y AD �'� <br /> Quantity Installed Discussed with geologist: - (y v <br /> Type of method <br /> EH 29 29 <br />