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MONITORING WELL INSTALLATION REPOR i <br /> Date: &ZAU CONSTRUCTION <br /> Premise Address:_,, � Gj/��-� Total Depth <br /> Screen Length (from) L/© (to) ,Z3� <br /> Well No. — �� Filter Pack (from) Zen (to) 23 <br /> Bentonite (from) -57 —(to)�� <br /> Inspector: /A Grout (from)_—2 (to)• S <br /> �� � C7 Drilling rig type � <br /> Permit No. D G i <br /> Auger O.D. r` I.D. <br /> Completion - Stove pipeA4!i ie (circle one) <br /> Drilling Company: <br /> Driller: Z��/ �^--� casing <br /> rr <br /> height <br /> Consultant —17 —E <br /> Geologist �nt/y •- T <br /> AiBQ -GROUND CNAIST'Y480X <br /> CONFLETION CCMPLPTICN <br /> SPECIAL PERMIT INFO. Gmund Surface <br /> r <br /> Distance to server line PIP grout <br /> Domestic well on site - (y/0)) `� Z ft. <br /> If yes, location and distance - ft• <br /> Ift. <br /> ti.. <br /> N <br /> C <br /> SAMPLING <br /> s.$D tlorni <br /> secicn <br /> Holding Temperature / �LP = VXVW Pack <br /> Method — <br /> Screening Method ;r _ <br /> Tracking Sheet - (y/ n ) )"�-� <br /> �.:I.: ft <br /> fL <br /> . <br /> SPOILS <br /> Storage Method �, L +:'3 MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/6? -2 "g <br /> �� <br /> Storage Location �� �S:I� Casing type — <br /> Blank Z 5— ft. Screen <br /> Slot size O 2- <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios _ Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />