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MONITORING WELL INSTALLATION REPORT <br /> Date: 1 a' 13I O CONSTRUCTION <br /> Premise Address: S (, � � �� �^ R� Total Depth qS <br /> Screen Length (from) 4 S (to) 25 <br /> Well No! W & 10 Cl Filter Pack (from) 4 % (to) Z 33 <br /> Bentonite (from) 13 (to) 21 <br /> Inspector: Grout (from) yl (to) r <br /> Drilling rig type Qi .i . Q FaL2LP' 1 41 <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: Cwsc �- <br /> rd-t- <br /> Driller: NEW casing <br /> he ±ght <br /> Consultant '4 <br /> -I^ <br /> Geologist h� °� �f �;�rl � -' •- T <br /> L A80VEwGRCUN0 <br /> 4YMS <br /> COWPLETION 0 - <br /> SPECIAL PERMIT INFO, vo CBcurd Sumacs <br /> Distance to sewer line grout <br /> Domestic well on site - ( y / n ) I ft, <br /> If yes, location and distance - L <br /> L 5 <br /> ft rt. <br /> SAMPLINGc ° <br /> slotted <br /> I tac'cn e <br /> Holding Temperature <br /> Method_ <br /> Screening Method <br /> Tracking Sheet - (`y)/ n ) <br /> SPOILS Q <br /> Storage Method IZOc*. MATERIALS/DEVELOPMENT <br /> Contamination Noted - (,y / n n7 ^ n / <br /> Storage Location /✓ L'; . 14W 11" Gtr Arrrati4 Casing type ^ P� sok �b <br /> Blank..J � ft. Screen Lo ft, <br /> Slot size 04 0 L O <br /> GROUTING Bags cement Y _, K <br /> Buckets bentonite 5 <br /> Depth to water 3 Bags sand/gravel '711070 <br /> Mix Ratios nx,uJb Filter Pack type/size 3 <br /> Installation Method 4 Surge Block: - ( yn <br /> Quantity Installed Discussed with geologist: - y / n ) <br /> Type of method <br /> EH 29 29 <br />