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MONITORING WELL INSTALLATION REPORT <br /> Date: 1 L s`/D CONSTRUCTION <br /> Premise Address: 1 y z6 s L w.�o�� Total Depth q 0 <br /> Screen Length (from) S 4 (to) £C S <br /> Well No.: Mki/ Filter Pack (from) �(to) IAS, <br /> T Bentonite (from) f;gt (to) -_�3'� <br /> Inspector: Grout (from) 0 (to) 62 " <br /> Drilling rig type Seen ie, <br /> Permit No. S Z of �,� Auger O.D. 6-T I.D. <br /> Completion- Stove pipe/c uistie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant_ <br /> Geologist CO f f l t4 •- <br /> ABOVE-GROUND <br /> COMPLETION CHRISTY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfac� �...� <br /> Distance to sewer line grout <br /> Domestic well ite - (y/ n ) _ ft. <br /> If yes, 1 on and distance - <br /> - C <br /> SAMPLINGdot <br /> ted <br /> aacton — <br /> Holding Temperature . <br /> Method _ 7" P <br /> ack <br /> Screening Method ::>N <br /> Tracking Sheet - (y/ n) <br /> 90 ft. <br /> SPOILS <br /> Storage Method c 6ai,� MATERIALS/DEVELOPMENT <br /> Contamination Note/ n) <br /> Storage Location Casing type Z "�'V <br /> Blank 15 ft. Screen 10 ft. <br /> Slot size '0-20 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 30 Bags sand/gravel <br /> Mix Ratios y^9'f , &A aknAnnr. Filter Pack type/size <br /> Installation Method Surge Block: - (y/ ii <br /> Quantity Installed ,,j %to 9&� Discussed with geoto�gist: - (y <br /> Type of method <br /> EH 29 29 <br />