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MONITORING WELL INSTALLATION REPORT <br /> Ql CSL CONS"IRUCTION <br /> Date: •T7 �,. <br /> SUS°1 )'1 l�tt Total Depth / <br /> Premise Address: Screen Length (from) '-t' (to) 5� <br /> Well No.: t'- f / Z Filter Pack (from) LO -(to) <br /> Bentonite (from) (to) <br /> 1 � Grout (fro ) _ (to)t F—all <br /> Inspector. Drilling rig type <br /> Auger O.D. S�`l�F' I.D. , - <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: V `A <br /> casing <br /> Driller• _ height <br /> Consultant / V e � <br /> Geologist AgpvE-GRCUND to <br /> CQ wPLE=N <br /> Ground Sulacs ' <br /> SPECIAL PERMIT INFO. <br /> prccR <br /> Distance to sewer line ft. <br /> Domestic well on site - (y/ n) a `� <br /> ft. <br /> If yes, location and distance - ft. <br /> >. r <br /> SAMPLING )o i �✓ M = <br /> socicn <br /> : <br /> _ paval pas <br /> Holding T pue <br /> Method ffA <br /> Screenin;Method <br /> Tracking Sheet - r� n) <br /> 1) L9_0 <br /> SPOILS <br /> S�. SS�� �N�f MATERIALS/DEVEi.OPMENT <br /> Storage Method tn- jai <br /> Contamination Not, d- ( /�) Casing type L <br /> Storage Location c ft Screen / —� <br /> Blank_r <br /> Slot size rf) > <br /> Bags cement i <br /> GROUTING Buckets bentonite <br /> Bags sand/gravel 5 100 — <br /> Depth to water 7 <br /> Filter Pack type/s e <br /> Mix Ratios Surge Block: - /n ) <br /> Installation Method Discussed with geologist. - / n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />