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MONITORING WELL INSTALLATION REPOn• <br /> Date: A b CONSTRUCTION <br /> Premise Address: lt90l) Al, Total Depth S� <br /> Well No.: Jl ' Screen Length (from) 5- (to) <br /> Filter Pack (from)--37—(to)—5-3 — <br /> Inspector: Bentonite (from) 'r9 (to) — <br /> p (fir Grout (from) 50 (to) J <br /> Permit No. CQ 6 s3 Drilling rig type_ Grur7y <br /> Auger O.D. $ I.D. 9- <br /> Drilling Company:_ <br /> Completion - Stove pipe/christie box (circle one) <br /> �f,�-- <br /> Driller:_ / 1�L <br /> �� � � � casing height <br /> Consultant L�� <br /> Geologist— `�U" T <br /> ABOVE-GROUND <br /> COAFLETION CHAISTY-BOX <br /> PLEnCN <br /> SPECIAL PERMIT INFO. ��g�� <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) 50 ft. <br /> If yes, location and distance - <br /> SAMPLING <br /> !!//^^ slatted <br /> Holding Temperature(Ly u0 CC4L2 N46 ucoon <br /> Method = V'VW Pack <br /> Screening Method <br /> Tracking Sheet - (y/ n ) 2 <br /> SPOILS <br /> Storage Method Olt t ✓yf MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n /� <br /> Storage Location/c)Mane Q c �� Casing type d"' SCA q / ✓L' <br /> Blank ft. Screen .3 ft. <br /> Slot size '0 /0 ' <br /> GROUTING Bags cement /D-o' Fr t 5 <br /> Buckets bentonite 2 <br /> Depth to water =3 ( Bags sand/gravel / <br /> Mix Ratios 3 -f II Filter Pack type/size /2 <br /> Installation MetlYod Surge Block: - (y(n <br /> Quantity Installed Discussed with geolVggist: - (y(D <br /> EH 29 29 Type of method <br /> /a//3/D 6 45 - D/ <br />