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MONITORING WELL INSTALLATION REPORT <br /> Date; $.I S I 10 <br /> CONSTRUCTION <br /> Premise Address: 11 — W t LA k � Total Depth <br /> nZI, siA4 04t"en -C, eus4� 1 <br /> Well No.: kV\kA)_�( � � Screen Length (from) S S (to) G <br /> Filter Pack (from)_ e 3 (to)_ 40 <br /> Inspector: (� Bentonite (from)T_(to)_. 5:3_ <br /> Grout (from) (to) <br /> Permit No. Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (c— ircle one) <br /> Driller: W1_t �1 <br /> 'V —` casing <br /> Consultant A/ height <br /> ABOVE-GROUND <br /> SPECIAL PERMIT INFO. COMPLETION CHAISN-BoX <br /> COMPLETION <br /> Ground Swire <br /> Distance to sewer lin <br /> Domestic well o to - (y/n ) gran <br /> If yes, locati and distance - <br /> _ ft. <br /> ft. <br /> s <br /> SAMPLING <br /> Holding Temperature_ <br /> Method <br /> Screening Method I = P <br /> Tracking Sheet <br /> SPOILS b D <br /> Storage Methodp� Q <br /> Contamination Noted - (y n ) t MATERIALS/DEVELOPMENT <br /> Storage Location <br /> Casing type Z `pyr <br /> Blank-- �ft• Screen <br /> GROUTING Slot size_p7=a <br /> Bags cement <br /> Depth to water ^/2 3 1 Buckets bentonite <br /> Mix Ratios Bags sand/gravel r <br /> Installation Method F Iter Pack type/size /ao <br /> Quantity Installed +P Wt.r:t,t. Surge Block: - (y/ <br /> Discussed with geologist: - (y/ <br /> EH 29 29 Type of method <br />