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MONITORING WELL INSTALLATION REPORT <br /> Date: E> I ! , C) O CONSTRUCTION <br /> Premise Address: J . Total Depth -4 S <br /> Screen Length (from)— I 10 (to) S i <br /> Well No.: M w- ` Filter Pack (from) �6 (to) uh. t <br /> Bentonite (from) 3 ' (to) z �, <br /> Inspector AAA4'01 Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/clu-istie box (circle one) <br /> Drilling Company: �(���w <br /> Driller: brn Jnr casing <br /> height <br /> Consultant �i P r r11 <br /> _-� <br /> Geologist L) fn1t:n„1 (AU <br /> ... <br /> ABCVE-GR UND C7-1fil5TY30X <br /> C�MPL�TION CCMPL-CMCN <br /> SPECIAL PERMIT INFO. Ground Suian <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) .33 <br /> If yes, location and distance - 36l ft. <br /> _ _ a <br /> = m <br /> = e <br /> SAMPLING = -' <br /> dorwi — � <br /> ax'cn <br /> Holding Temperature _ gavdpack <br /> Method ��� <br /> Screening shod 1 r` <br /> Tracking Shcet - ( y/ n ) _ <br /> SPOILS <br /> Storage Method 1h c MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y n� <br /> Storage Location Casing type i1 w <br /> Blank �I�fr. Screen <br /> Slot size o Z.o <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water_ 62-r I�I�ZU ', S}rk(q e&4 �5-. 1 Bags sand/gravel <br /> Mix Ratios Filter Pack type/sizez��0 <br /> Installation Methodkin h, ,. v Surge Block: - ( y/ n ) <br /> Quantity Installed I Discussed with geologist: - ( y/ n ) <br /> EH 29 29 Type of method <br />