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MONITORING WELL INSTALLATION REPORT <br /> Date:- cl 1 1.•© t) CONSTRUCTION <br /> Premise Address: � Total Depth l oD <br /> Screen Length (from) S (ro) /e5z:)' <br /> Well No.: lYl w-;S Filter Pack (from) (to)_ /e01 <br /> Bentonite (from) c? L- 5 ` ([o) 9y s' <br /> Inspector- Grout (from) } <br /> Drilling rig type <br /> Permit No. S 2 ` 3 j Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> Cos Arc---, < - � 'Vheight <br /> n ultant <br /> Geologist 6,0 LIG/ <br /> • 1,_POVE-GRC4JND Ck S?Y X <br /> SPECIAL PERMIT INFO. Grou xi Sui3ce <br /> Distance to sewer line or« <br /> Domestic well on site - n) <br /> If yes, location istance - b ft <br /> M <br /> C <br /> S AMP LI NG <br /> tlorc� � <br /> Holding Temperature <br /> Method <br /> Screen' ethod <br /> Tra g Sheet - (y/ n ) =` _ <br /> 00 n, 'V = ft. <br /> SPOILS <br /> Storage Method S Sr � „� MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ <br /> Storage Location Casing type Z " PVC- 50A,( Ya <br /> Blank f[. Screen ft• <br /> Slot size , 0 2O <br /> GROUTING Bags cement ti So -14 <br /> } <br /> Buckets bentonite 4416 ;oe <br /> Depth to water_ ^/ S51- Bags sari -ravel Z 6— _ <br /> Miz Ratios ,sv CL (� / VO .LA r4na-k 1 Filter Pack type/size <br /> -installation Method _ 9 Surge Block: - ( y/ it ) <br /> Quantity Installed Discussed vrith geologist: - (y/ n ) <br /> Type of mctliod <br /> EH 29 29. <br />