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MONITORING WELL INSTALLATION REPORT <br /> k <br /> • Psi . <br /> Date: v v 9 CONSTRUCTION <br /> Premise Address : / c) <br /> 7 �he Alc Total Depth <br /> NZ �5 <br /> ' S Screen Length (from) 14.> CEO) <br /> Well No.: W Filter Pack (from) (to) Z-S <br /> / , Bentonite (from) (to) f� <br /> InspectorGGrout (from) (to),�51 _ <br /> Drilling rig type <br /> Permit No. Auger O.D. //S I.D. (o <br /> `� � Completion - Stove pipe/chrisrie box (circle one) <br /> Drilling Company: / 4 S / <br /> Driller: C� Ajo ✓v ZlC casing <br /> IFm � height <br /> .Consultant � ' t� �```+"• .�`'� /� - � <br /> Geologist <br /> ABOVEGRCUND ChA4S{Y30X <br /> COMPLETION C:tk,iPLETION <br /> SPECIAL PERMIT INFO, Ground S <br /> Distance •to sewer line drat <br /> Domestic well on site - { y / n ) _ II <br /> If yes, location and distance - I � nt <br /> 1. <br /> ft. <br /> c <br /> SAMPLINGor.. '4- <br /> a cn <br /> Holding Temperature <br /> Method <br /> Screening Method =ac = <br /> Tracking Sheet - ( y / n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) 1 se - <br /> Storage Location Casing type <br /> Blank �3i /d fr. Screenfr - <br /> Slot size lJad <br /> GROVRNG Bags cement !y <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel / Z maolp? . <br /> Mix Ratios Filter Pack type/size <br /> -installation Method Surge Block: - ( y / n ) <br /> Quantity installed Discussed with geologist: - ( y / In ) <br /> Type of method <br /> EH 29 29 1 yfit( <br />