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MONITORING WELL INSTALLATION REPORT <br /> Date: y 0 0 CONSTRUCTION <br /> Premise Address: , <br /> Total Depth��.�l „��, <br /> Screen Length (from) (to) �� <br /> WeII No.:� YVt. W _ -3 � Filter Pack (from) -4- <br /> Inspector. �� tn.+,. ���+ Bentonite (from) (to) I <br /> Grout (from) -�- {to)� <br /> Permit No. Drilling ng type <br /> Auger O.D. —ED-- <br /> Drilling Company: -C , Completion - Stove pipe/ iristie boy (circle one) <br /> f. <br /> Driller: <br /> casznq <br /> Consultant u0nd C&L 4 + . �. he_ght <br /> '4' <br /> _Q <br /> Geologist '' -' _ VT <br /> AZCVE-GtgC(JND <br /> CO&PLETICN C44RZ Y-30X <br /> SPECIAL PERMIT INFO. CCMPLEMN <br /> Grund Sufact <br /> Distance to sewer line Qr= <br /> Domestic well on site y/n) <br /> If yes, location distance - <br /> SAMPLING <br /> soden -" <br /> Holding Temperature = <br /> Method ' ` �ra,ral pack <br /> Screening Me <br /> Tracking cet n ) t - <br /> 11. <br /> SPOILS <br /> Storage Method .— MATERIALS/DEVELOPMENT . t. . <br /> Contamination Noted - ( y <br /> Storage Location Casing type . <br /> Blank ft- Screen O h. <br /> GROUTING Slot size o2.0 <br /> Bags cement <br /> r f. Buckets bentonite"tf z " <br /> Depth to water 1 Bags sand/gravel .6 <br /> Mix Ratios i r " " - # Filter Pack <br /> type/size <br /> Installation Method Surge Block: - ( y/ i <br /> Quantity Installed • : ' Discussed with Discussedgeologist: - (y/ <br /> EH 29 29 Type of method <br /> 1 , <br />