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MONITORING WELL INSTALL.AUON REPORT <br /> Date: ) 2_4 p CONSTRUCTION <br /> Premise Address: Z` ?- 5,vs�-(,, S- Total Depth <br /> Screen Length (from) I301 (to) 1 4v <br /> Well No.: YV\yj Filter Pack (from) (to) 14Y <br /> Bentonite (from) ��� (to) 13-�-- <br /> Insvector. ASA r-C' L--- Grout (from) (to) 13S <br /> Drilling rig type <br /> Permit No. S I Auger O.D. I.D. <br /> Completion-Stove pipe/christie bar (circle one) <br /> Drilling Company: C�-.��c�+rQ,t <br /> Driller. 1 0 "* T casi-ng <br /> T he,ght <br /> IV i 71 'V <br /> Consultant <br /> R o o <br /> ,. L oV— 1 <br /> ra. :H <br /> Geologist J1BCV-5-G-RC:UND A <br /> =W'_= ZN d- iS S 1 c3CX <br /> SPECIAL PER-'V97 INFO. 'Scs!aes <br /> Distance to sewer line � <br /> Domestic well on • (y/ n ) <br /> If yes, locari and distance - <br /> SAN/PLING slorlad = <br /> Holding TempeaLure _ PCk <br /> Memod '— <br /> Sceeni.n mod <br /> Trac ' g Sheet - (y/ n ) _ <br /> ;L ♦ = r tL <br /> SPOILS PP <br /> Storage Methodt- / <br /> �W"`"— MATERIALS/DEVELOPNIENT <br /> Contamination Noted n ) casing type Z V C <br /> Storage Locarion 5 ft. <br /> Blank i 3� fL. Screen <br /> Slot size o 0 <br /> GROL�ITNG Bags cement <br /> Buckets bentonite u <br /> Depth to water "� y b Bags sand/�av� d } <br /> Mix Ratios -4 t `14 A4 LFilter Pack typesize 2 1 Z <br /> Installation Merhod M% �'S- ' c enu Surge Block: - (y/� <br /> Quantity Installed i Discussed with geologist: - (y/0 <br /> Type of method <br /> EH 29 29 <br /> E <br />