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arm 'Iwo, <br /> MONITORING WELL INSTALLATION REPOn f <br /> Date: N'9 V CONSTRUCTION <br /> Premise Address: �Y`z! �/. /� 1/V 5lloreo' Total Depth <br /> Screen Length (from) 5 (to) 100 <br /> Well No.: ya Filter Pack (from) 16110ND (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> S Drilling rig type <br /> 41 <br /> Permit No. �y Auger O.D. I.D. <br /> Drilling Company: Completion- Stove pipe/christie box (circle one) <br /> ( // ,, <br /> Driller: a'4'/` cas ing <br /> IV - <br /> height <br /> Consultant Zd U <br /> Geologist G <br /> ABOVE-GROUND <br /> COMPLETION CHCOAPlEISE-BOX <br /> TiON <br /> SPECIAL PERMIT INFO. Ground Sur— <br /> Distance to sewer line '-7 grout <br /> Domestic well on site - (y 0 ft• <br /> If yes, location and distance - p� <br /> .1Lft. ft. <br /> SAMPLING slotted <br /> ��� secdron = <br /> Holding Temperatur <br /> pack <br /> Method = `�� <br /> Screening Method <br /> Tracking Sheet - y n ) <br /> -�00 ft• � -- n• <br /> SPOILS <br /> Storage Method aV1 f �(��� MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type Z•` S-k 46C <br /> Blank f 5 ft. Screen �ft. <br /> Slot size -biA <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel trb a <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y <br />" Quantity Installed Discussed with geo ogist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />