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MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> 1 (2 i 3 CONSTRUCTION <br /> Premise Address: PgQI C Total Depth II <br /> Screen Length (from) (to) <br /> Well No.: M u.3 um –AkA lmwia►-Al- Filter Pack (from) Z `IJ (to) <br /> �l Bentonite (from) t 43 (to) e <br /> Inspector: ✓ ✓�� °�/tH/ Grout (from) Suc�6cp- (to) Ll3 <br /> Drillingrigtype Sor-.�C, <br /> Permit No. SR410(, B S 3 Auger O.D. 95/V I.D. <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: e,0.S CO.CLC <br /> Driller: ocrn casing <br /> height <br /> Consultant (Lrn <br /> Geologist L(n4-54y ac ' <br /> ABOVE-GROUND CHRISrYwx <br /> COLFLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surt'ce <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) v31_m.. mw.31-AL �t�Lrl__n. <br /> If yes, location and distance - J L g <br /> 4 <br /> x = <br /> - <br /> m <br /> — o <br /> _ <br /> 0 <br /> SAMPLING abttad <br /> aacdon —_ E <br /> Holding Temperature = prawl pack <br /> Method <br /> Screening Method — <br /> R — <br /> Tracking Sheet (y/n) , <br /> SPOILS —151 L} s t r <br /> r <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type 50h 40 'PVC, <br /> Blank °'ISS � (09ft. Screen I o w 10 ft. <br /> Slot size 0 - 01 0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />