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Sent By: HP LaserJet 3100; 44; Dec-1 -" 7:11AM; Page 4/5 <br /> 1 <br /> ONITORING WELL INSTALLATION REPOKr� <br /> Date:_ I���1 (( CONSTRUCTION <br /> Premise Address: -,V l woLh l,C'/w� Total Depth <br /> Screen Length (from) 039 (to) <br /> Well No.: S y � Filter Pack (from) (to)�_ <br /> Bentonite (from)�(to) S- <br /> Inspector. Grout (from) :2;� (to) 4K <br /> Drilling rig type5A o, <br /> Permit No. Auger O.D. 1B S - I.D. <br /> Completion - Stove pipe/christie boa (circle one) <br /> Drilling Company: 4A. t c <br /> Driller: �bµ-- height <br /> Consultant <br /> LFA g <br /> Geologist 5 <br /> ABOVE-0AOUND C>•6it5T'Y•BOX <br /> C0AK+I.ET1ON CCOPLETION <br /> SPECIAL PERMIT INFO. <br /> Distance to sewer line stout <br /> Domestic well on site - (y/ n) S� h <br /> If yes, location and distance - <br /> IL <br /> SAMPLING sloftd <br /> sseiton w _ •�, <br /> Holding Temperature - + grav1pack <br /> Method _ t' <br /> Screening' Method ' <br /> Tracking Sheet - (y/ n) <br /> SPOILS �arj <br /> Storage Method MATERIALS EVHLOPMENT <br /> Contamination Noted- (y/ n ) n. <br /> Storage Location Casing$ type b fr Screen_-' <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentQnite <br /> Depth to water Bags sand/Snivel <br /> Mia Ratios Filter Pack type/sizel <br /> Installation Method Surge Block: (y/n) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />