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MONITORING WELL INSTALLATION REPORT <br /> Date: II/1$/2?1 y CONSTRUCTION <br /> Premise Address: 938 6ro.4 ye_ t o, Rigo SCA Total Depth r <br /> Screen Length (from)' <br /> (eS S ' (to) 04 / <br /> Well No.:_ EX- 1 (to) w <br /> Filter Pack (from) <br /> Bentonite' (from) 3S' (to) 3& <br /> Inspector: . �n/' yoa� Grout (from) 3�—(to) o' <br /> Drilling rig type #Qle w .S,IcaLw A4•ev <br /> Permit No. Auger O.D. I.D. <br /> Completion Stove pi Christie box (circle one) <br /> Drilling Company:_CcesGasls bri11iNy <br /> Driller: ro.-i SaJa.-ion✓ Y i <br /> casng <br /> T Z/ <br /> Consultant�msi% L:nainccpiT gr-dCVc%peygQ,� <br /> height <br /> Geologist Cjti 11..x,. a.,L <br /> ABOVE-GROUND <br /> coNPL_710N CFfr1IM43OX <br /> SPECIAL PERMIT INFO. COMPLETION <br /> Ground SuAaca <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) fe <br /> ' <br /> If yes, location and distance - 1 tt. <br /> 4/p ' ?a e ft. <br /> Tti P <br /> ' � m <br /> SAMPLING ■lotted = g <br /> Holding Temperature Pa S. p I� Yc xrni <br /> Method <br /> Screening Method uet <br /> Tracking Sheet - (y/n) ' _ <br /> G <br /> tt. <br /> SPOILS <br /> Storage Methodj3atti MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location 62 � .,' ; ,,_o4 .91ei1uli Casing type_ dek, W Pyle <br /> Blank YO/ ft. Screen 21.: ' ft. <br /> Slotsize O,cW /' <br /> GROUTING Bags cement All, <br /> I Buckets bentonite_ <br /> Depth to water ATP.ax. 30 Bags sand/gravel �1S' <br /> Mix Ratios Filter Pack typesize <br /> Installation Method <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> EH 29 29 Type of method <br />