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MONITORING WELL INSTALLATION REPORT <br /> Date: 3 20 <br /> CONSTRUCTION <br /> Premise Address: 3o8 N •6CR Total Depth 36 ' <br /> Q Screen Length (from)' Zo (to) <br /> Well No.: <br /> V -8 Filtet,Pack (from)�(to) <br /> Inspector _ 1 - o'RKu+^1 Bentonite' (from)_ t (to) I <br /> Grout (from_ ) 1-47 (to) _ <br /> Drilling rig type Qo r*&-j <br /> Permit No. Auger O.D. g'` I.D. <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company:_ A W iq <br /> Driller: 11GuiL casing <br /> height <br /> Consultant &6 <br /> Geologist 19NI(-iL 1/. _ <br /> ABOVE-GROUND <br /> COwLETION CHRZ-ry-BOX <br /> SPECIAL PERMIT INFO. G�rd gLxf� COMPLETION <br /> Distance to sewer line / grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - I ft. <br /> 2� ft. <br /> SAMPLING alattnd = c <br /> Holding Temperature __ <br /> Method — vn+�+P <br /> Screening Method <br /> � <br /> d <br /> Tracking Sheet - (y/n) — <br /> _ft. = 1 ft• <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type 5014404.E 41 Z) <br /> Blank 2u ft. Screen 1`S ft. <br /> Slot size O ,0 20 <br /> GROUTING Bags cement G v7) <br /> Buckets bentonite ! [ <br /> Depth to water Bags sand/gravel_� <br /> Mix Ratios Filter Pack type/size ¢ <br /> Installation Method Surge-Block: - (-y04 _ __Quantity Installed Discussed with geologist: - (y/X) <br /> EH 29 29 <br /> Type of method <br /> ' <br />