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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> ,,� <br /> Premise Address: z50_ �ttf R lam` Total Depth <br /> Well No.: M S7 Screen Length (from) 10Y (to)�'( <br /> Filtet Pack (from) /02 (to) i/y <br /> Inspector: J• y6� Bentonite' (from) /00 (to) /0 Z_ <br /> Grout (from) D•S (to) /o O <br /> Drilling rig type cm q <br /> Permit No. 5eC0(o 4 2 4 Auger O.D. z I.D. ly, Z r' <br /> Drilling Company: <br /> Completion- Stove pipe/christie box (circle one) <br /> C'/�StaDE <br /> Driller: <br /> casing `$ ,L <br /> height 4� <br /> Consultant 44 1W / �- <br /> Geologist MARK A/, _ T <br /> ABOVE-GROUND <br /> COMPLETION CtiRIM_BOX <br /> SPECIAL P RMIT INFO. Ground Surface <br /> COMPLETION <br /> Distance to ewer line Grocrt <br /> Domestic we on site . (y/n) lcXj ft <br /> If yes, location d distance - <br /> 10 — to 2 ft. <br /> tt. _ <br /> SAMPLING — <br /> "• o <br /> slatted va = g <br /> Holding Temperature _ P <br /> Method <br /> Screening Method — <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method nitM /0 rT� 2 MATERL41S/DEVELOPMENT <br /> Contamination Noted - (y I. <br /> Storage Location Casing e Sc t; yo I V C <br /> tYP <br /> Blank /o y ft. Screen /0 g. <br /> Slot size 0,020 <br /> GROUTING / Bags cement n 7-5/ <br /> 5 Buckets bentonite_ / <br /> Depth to water Bags sand/gravel A� <br /> Mix Ratios_ / 6 , 624W46, Filter Pack typesize <br /> Installation Method_ T�t.,,,Z _ _ Surge Block:.-_(.y/n __ _ <br /> Quantity Installed 3 &*Fth4y{ <br /> Q t3' Discussed with geologist: - ( /n) <br /> EH 29 29 Type of method <br />