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MONITORING WELL INSTALLATION RFPORT <br /> Date: 2 [ I f 3 CONSTRUCTION <br /> Premise Address: AJ� c)"7 O&Lyt Total Depth <br /> Well No.: lAl _(� Screen Length (from) g (to) <br /> Filter Pack (from)—(to) i <br /> Inspector- I�� ( � v Bentonite (from) 7 (to)_12� _ <br /> Grout (from) (to) <br /> Permit No. �zl�5 Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company_ Completion - Stove pipe/cluistie box (circle—one) <br /> Drller._ IN AN <br /> casing <br /> Consultant C„ V" 7 'r height <br /> f 9. <br /> Geologist <br /> ABCVE-GRCUND <br /> COkPLETION CNA StY30X <br /> SPECIAL PERMIT INFO. COMPLEPCN <br /> Grind Suiact <br /> Distance to sewer line <br /> Domestic well on sit iron <br /> If yes, location distance n ) <br /> S2� ' ft. <br /> _ - a <br /> SAMPLING - c <br /> 0 <br /> �Ior.A7 — c <br /> Holding Temperature i0Icn <br /> Method o = pavalya <br /> n <br /> Screening Method_ <br /> Tracking Sheet - (y/ n ) <br /> 9`4 <br /> SPOILS ft. — n. <br /> Storage Method <br /> Contamination Noted - y ) MATERIALS/DEVEI OPMENT <br /> Storage Location rn S[ <br /> Casing type_ <br /> Blank q.n ft. Screen <- fr <br /> GRANG Slot size <br /> Bags cement <br /> Depth to water N-/(-Z' Buckets bentomte <br /> Mix Ratios 2c� Bags sand/gravel <br /> Installation Method D Filter Pack type/size C�___Q <br /> Quantity Installed Surge Block: - (y t TGOY <br /> Discussed with geol t: - ( y <br /> EH 29 29 Type of method <br />