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MONITORING WELL INSTALLATION REPORT <br /> Date: j <br /> CONSTRUCTION <br /> Premise Address:_X 3D Iuj)a$mj Fc. Total Depth -72 % <br /> Well No.: M 5 G-✓} Screen Length (from)' S O <br /> Filter Pack (from) (to) 70 <br /> Bentonite' (from) .510 (to) <br /> Inspector: J•10a*4N? Grout (from) 0,5 (to) Sb <br /> Drilling rig type € <br /> G <br /> Permit No. 2y 5 Auger O.D. RteI.D. ZS <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: LI041C4¢DE <br /> Driller: c as ing <br /> height <br /> Consultant ��'°i� -��� <br /> Geologist iI 41(K N. <br /> ABOVE-GROUND <br /> COMPLETION CHAI57 4= <br /> COMPLETION <br /> SPECIAL PE NFO. ��gu{� <br /> Distance to sewer line Gr«rt <br /> Domestic well. on site • /n. ft <br /> If yes, location and distance <br /> ft. <br /> ft. <br /> 0 <br /> SAMPLING — <br /> Coned = 8 <br /> aacdon ?� _ <br /> Holding Tempe e _ P <br /> Method <br /> ack <br /> Screening Method _ <br /> Tracking Sheet - (y/n) _ <br /> SPOILS <br /> Storage Method Uk K PS P@/', MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y <br /> Storage Location Casing type 2 " Sa y0 PVC <br /> Blank_____( 0 H. Screen /U ft. <br /> Slot size 1).07 0 <br /> GROUTING Bags cement 'Ll! <br /> Depth to water 3 5 / Buckets bentonite / r <br /> 5- <br /> Bags sand/gravel /D <br /> Mix Ratios F3 3on,,srea5 Filter Pack type/size 1/? <br /> Installation Method-_say iE <br /> Quantity Installed 3 t3ey1/4e[Ft Discussed with geologist: - (4�9/ n) <br /> EH 29 29 Type of method <br />