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MONITORING WELL INSTALLATION REPORT <br /> Date:_ I I OX CONSTRUCTION <br /> Premise Address---4O q's'- Mar a r y S� Total DepthScreen Length <br /> Well No.: =45 Filter Pack Well L O o ` ([o)_. 10 <br /> (from) _(to)- I n S <br /> inspector. _ (lt,,,,� o, Bentonite (from)_ (to) <br /> Grout (from) (to) <br /> Permit No. Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company:—Q=d,� Completion - Stove pipe/chrisde box (c— irde one) <br /> Driller. <br /> casing <br /> Consultant 0 ,p, <br /> height <br /> Geologist �tn D pinnq�n <br /> ABCVE-GACUND <br /> COWLETION c.`R*7Y30X <br /> SPECIAL PERMIT INFO. COhtPLncN <br /> - Grocmd Strfact <br /> Distance to sewer line orae <br /> Domestic well on site - I in ) <br /> If yes, locadon an stance <br /> br, ft• � h- <br /> ?.. a <br /> _ o <br /> SAMPLING <br /> 0 <br /> tlorai — c <br /> Holding Temperature soden = <br /> Method it <br /> -- (a 0 = Loft. <br /> Screening Method u <br /> Tracking Shcet - / n ) <br /> SPOILS <br /> Storage Method5 fOI O MATERIALS/DEVELOPMENT . <br /> Contamination Noted - (y .n <br /> Storage Location Casing type <br /> Blank_ (on ft Screen .S ft. <br /> GR_ OUTTINGG Slot size .OZO <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> Mix Ratios Bags sand/gravel <br /> Installation Method Filter Pack type/size 3ILtoN �y <br /> Surge Block: - y n ) i <br /> Quantity Installed Discussed with ologist•. • (y n` <br /> EH 29 29 Type of method <br />