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MONITORING WELL INSTALLATION REPOni <br /> Date: 7��q CONSTRUCTION <br /> Premise Address:: Total Depth 6L) <br /> Well No.:—45 /�o f45 2- Screen Length (from) (to) $,,�_ <br /> Filter Pack (from)—�0 ' (t0)7 - <br /> Inspec[or: �, Bentonite (from) (to) -/S/ <br /> Grout (from) 5/ (to) 3 <br /> s1C D0�lpe j Drilling rig type Jj <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box circle one) <br /> Drilling Company: /- <br /> Driller: — <br /> � 1 f d� fV <br /> casing <br /> Consultant Z-" \ height <br /> Geologist yt�xco� <br /> ABOVE-GROUND <br /> CCAFLETION CH Z Y-BOX <br /> SPECIAL PERMIT INFO. COMPLETION <br /> �--�Ground SuA <br /> Distance to sewer line C Z�rO Or«n <br /> Domestic well on site - (yn 6-1 If yes, location and distance . ft• <br /> h. <br /> ft. <br /> — a <br /> _ - m <br /> = m <br /> SAMPLING — o` <br /> aloud — 2 <br /> �� <br /> Holding Temperature_ &41 l G/UH �C�ce yQ—/oL — <br /> Method = vivo'Pack <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> SS n. ft. <br /> SPOILS <br /> Storage Method f /,00 MATERIALS/DEVELOPMENT <br /> Contamination No ed - (y n <br /> Storage Location� Casing type Z dtf 6e <br /> Blank ft. Screen j ft. <br /> Slot size .016" <br /> GROUTING Bags cement O <br /> �7 3�� Buckets bentonite ^-Z <br /> Depth to water Bags sand/gravel / <br /> Mix Ratios 0 t u Filter Pack type/size <br /> Installation Med d Surge Block: - (y/ n) <br /> Quantity Installed Discussed with geologist: - (y/n ) <br /> 2929 <br /> Type of method <br /> 14,110,4 4-5,2,2- S-/� <br />