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MONITORING WELL INSTALLATION REPORT <br /> Date:__ 7/ZL- Z 4ID 5 CONSTRUCTION <br /> � <br /> e <br /> Premise Address://odgCr w`^ ' lnn'�' - Total Depth 60 <br /> Screen Length (from) (to) <br /> Well No.: 5tie I - Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: V <br /> Driller: casing <br /> Consultant kt.un jIff <br /> LT height <br /> Geologist <br /> ABOVE-GROUND IEWT <br /> COWLETION CHRI Y-BO% <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surlaca <br /> out <br /> Distance to sewer line " r i arZl <br /> D yes, <br /> well on site • (y/ n ) a` Ift. <br /> ife , location and distance - L <br /> n. <br /> n. <br /> 27 0 <br /> go _ <br /> SAMPLING abttad = S <br /> aoc5on <br /> Holding Temperaturegraysw= P <br /> ack <br /> Method d `7 <br /> Screening Method -_ <br /> Tracking Sheet • (y/ n ) <br /> n. = n. <br /> SPOILS 60 <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type •�a <br /> Blank ft. Screen ft. <br /> Slot size /} d/n <br /> GROUTING Bags cement <br /> Buckets bentonite CO x Z <br /> Depth to water A-5-2- G f Bags sand/gravel <br /> Mix Ratiosj� Filter Pack type/size 'L4 -- <br /> Installation <br /> LLInstallation Method Surge Block: - (y/ <br /> Quantity Installed Discussed with geologist: -CY/ n ) <br /> Type of method <br /> EH 29 29 <br />