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MONITORING WELL INSTALLATION REPORT <br /> Date: 9�+ 9 13 CONSTRUCTION <br /> L rg/L 1361V Total De th 1 O � <br /> Premise Address: �- P <br /> Screen Length (from) 9H (to) ioN' <br /> Well No.: Filter Pack (from) 92 (to) I� <br /> Bentonite (from) <br /> Inspector: J-1ARKY0 Grout (from) D (to) SY, <br /> Drilling rig type SONIC <br /> Permit No. S � (O Auger O.D. / " I.D. <br /> " Completion - Stove pipe/ hristie bo (circle one) <br /> Drilling Company: `jgfGgl7E <br /> Driller: N'M&A NvaGEtt_ casing <br /> IffT <br /> height <br /> ConsultantF-RM <br /> Geologist Civ-f 14oPES •- <br /> ABOVE-GROUND <br /> COhFLEfION CCHR PM-HAIS'TY-BOX <br /> 10N <br /> SPECIAL PERMIT INFO. Ground S'°i'o° <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) ft. <br /> If yes, location and distance - 9H z ft. <br /> ft. <br /> — o <br /> — e <br /> — o <br /> SAMPLING Monad <br /> asc5on —_ <br /> Holding Temperature - gy„d pack <br /> Methodv <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> G i tt t o ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type X30 i c- - <br /> Blank JP�✓G 5z H 4 ft Screen Iv ft. <br /> Slot size 6 01 _ <br /> GROUTING Bags cement �G <br /> Buckets bentonite '3 BkL.t <br /> Depth to water, Bags sand/gravel G 3 k 55 s <br /> Mix Ratios Filter Pack type/size 7- 1•z- sa ^'t' <br /> Installation Method Surge Block: - (y <br /> Quantity Installed Discussed with gedoogi"st: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />