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^'MONITORING WELL INSTALLATION REPOn: <br /> Date: / 2,004P , 1 CONSTRUCTION Q <br /> Premise Address: �37 FAN/ Total Depth / fi <br /> /2 � Screen Length (from)_ y (to) 7 <br /> Well No.: %%//�� Filter Pack (from) 2i (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) d t 2%z <br /> p Drilling rig type /ale-77 h1nD <br /> Permit No. 0 Auger O.D. Z I.D. 4' <br /> �f Gt/ Completion - Stove pipe/christie box (circle one) <br /> Drilling If- <br /> Company: <br /> � <br /> Driller: /lam t a� #Ai�-vr:-GRCUN <br /> sing <br /> / fight <br /> Consultant <br /> (/til Cf <br /> Geologist CNAISTY BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. / G=nd Surf'°° <br /> Distance to sewer line N�ii gra <br /> Domestic well on site - 0nft. <br /> If yes, location and distance - , /h wNA ft. <br /> _ c <br /> SAMPLING slotted = ' <br /> secdon <br /> Holding TemperaWre _ gravel pyyt <br /> Method <br /> Screening Meth' <:> <br /> Tracking Sheet - y n ) <br /> SPOILS n _ / / _ �/ <br /> Storage Method l"' AA-e MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y A0 <br /> Storage Location Casing type <br /> Blank 71- ft. Screen <br /> Slot size Ol0 <br /> GROUTING Bags cement /S <br /> _ Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios 5 D Filter Pack type/size 7e I <br /> Installation Method r Surge Block: -(D n ) 4d <br /> Quantity Installed Discussed with geologist: - n) <br /> Type of method_ <br /> EH 29 29 <br />