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MONITORING WELL INSTALLATION REPbklr <br /> Date: CONSTRUCTION <br /> Premise Address: 3555 FkA'A oz- &&r Total Depth 3D r <br /> Screen Length (from) (to) 20' <br /> Well No.: M W-a Filter Pack (from) _(to) I(L ' <br /> Bentonite (from)—E c;� (to) IS' <br /> Inspector. _ mss✓ Grout (from) (to) 11 <br /> Drilling rig type <br /> Permit No. OZ OJ �(o Auger O.D. I I.D. U 5 g <br /> Drilling Company: Vyqll� <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Driller: 2YAN casing <br /> height <br /> Consultant A-1-C— '4 \ <br /> Geologist p L <br /> ABOVE-GRCUND <br /> COMPt fiT10N CH�iIM43OX <br /> SPECIAL PERMIT INFO. <br /> Distance to sewer line grout <br /> Domestic well on site - (y/Cro1 `o ft. <br /> If yes, location and distance - <br /> 7A ft. <br /> — w <br /> SAMPLINGslored <br /> iYC'1Cn <br /> Holding Temperature—4 <br /> Method — <br /> Screening Meth d <br /> Tracking Shcet n ) (`.�ruu rcE CUSIV+7H <br /> VV 3o ft <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ <br /> Storage Location foibiWh Ai4wi5 Casing type SYN 4D <br /> Blank U h. Screen in ft. <br /> Slot size <br /> GROUTING Bags cement ?�, <br /> t Buckets bentonite 1 b'Uk tai <br /> Depth to water f h. 5 h4C Bags sand/gravel <br /> Mix Ratios q.s 4 / 2416 Si�ciG Ql� Filter Pack type/s'ze <br /> Installation Meths Surge Block: - (�y/ n ) <br /> Quantity Installed Discussed with geologist: - (©/ n) <br /> Type of method �Wtlt�Zt_� p15►DtJ <br /> EH 29 29 <br />