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MONITORING WELL INSTALLATION REPORT <br /> Date: N I b�6 CONSTRUCTION <br /> Premise Address:_ 5'ct ol &,, „ k,4 Total Depth �$ <br /> Screen Length (from) 0 (to) 9-0 <br /> Well No.: low - Filter Pack (from) c-r' (to) R 2_ <br /> Bentonite (from) , (to) 5-Ar <br /> Inspector: Grout (from) (to) 56 <br /> Drilling rig type <br /> Permit No.__ � 3 p 2 Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: a �e <br /> Driller: �2(rr casing <br /> height <br /> Consultant ,�(T�, <br /> Geologist_ r2�t H 1 44(n ( -N „4. 0 tr f[ <br /> T— ABOVEGROUND <br /> 00WLE'rCN C-RLM43OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground SkOws <br /> Distance to sewer line Ori <br /> Domestic well on site - (y . <br /> If yes, location an e - n• <br /> (6-0 n. ft. <br /> V _ <br /> p <br /> C <br /> SAMPLING = ° <br /> o _ j dotted _ B <br /> ax7on <br /> Holding Temperature <br /> Method = g"`W Pack <br /> Screening Meth = <br /> Trac ' eet - (y/ n) <br /> _n. = FSS n. <br /> SPOILS U— <br /> Storage Method L, MATERIALS/DEVELOPMENT <br /> Contamination Note- (y/ n ) <br /> Storage Location rrv.h j fin^ Casing type (-"-CE,uwho . .S,(e�4- " 5--4 <br /> Blank 6 O ft. Screen " o ft. <br /> Slot size loin <br /> GROUTING Bags cement n. 10 <br /> Buckets bentonite <br /> Depth to water �vZ S Bags sand/gravel O - 5otf6 e <br /> Mix Ratioses Sze 6"4 Filter Pack type/size 1 I Z <br /> Installation Method �� es' Sze <br /> Surge Block: - (y/ n ) <br /> Quantity InstalleDiscussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />