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MONITORING WELL INSTALLATION REPORT <br /> Date: I�3 Q CONSTRUCTION <br /> Premise Address: x� /V - &RANT r <br /> Total Depth 36 <br /> Well No.: U W- (o Screen Length (from) (to) L7 <br /> Filtei Pack (from) 36 (to) <br /> Bentonite' (from) 8 (to) <br /> Inspector: J . o✓�KW�I Grout (from) 7 (to) <br /> Drilling rig type- "M V--76 6-r1" <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: A W j/} <br /> Completion - Stove pipe stie box ircle one) <br /> Driller:_ FvSE <br /> p casing <br /> Consultant height <br /> Geologist bANIE! V Ut-n /aG✓i4 <br /> V ABOVE-GROUND <br /> CONPLE-r}ON CHR15N4 X - <br /> SPECIAL PERMIT INFO. COMPLETION <br /> / 6ra:rYi Surface <br /> // / <br /> Distance to sewer line grout <br /> Domestic well on site - (Y/n) <br /> If yes, location and distance APtt <br /> Iv ft tt. <br /> 'r = _ '21 . <br /> = m <br /> SAMPLING — c <br /> ■bttsd — � 0'c <br /> Holding Temperature 16<710n <br /> Method = <>nvW» <br /> Screening Method = <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method ( N <br /> Contamination Noted - MATERIALS/DEVELOPMENT <br /> CY/n) <br /> Storage Location <br /> Casing type .2 4 P V C <br /> Blank /0 ft. Screen 2 g, <br /> GROUTING Slot size 03-0 <br /> -3 3 Bags cement---7K-::C y7i85 <br /> Depth to water Buckets bentonite- l/2 iTNs OHr/s <br /> Mix Ratios / P2uM Bags sand/gravel- <br /> Installation Method Filter Pack type/size it <br /> - ur e -- <br /> Quantity Installed.- � BAGS iJq� ------ - Sg .Block:__(-y-/n -- - <br /> Discussed with geologist: <br /> EH 29 29 Type of method <br /> �. Avk <br />