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MONITORING WELL INSTALLATION REPORT <br /> Date:_ CONSTRUCTION <br /> Premise Address: <br /> Total Depth <br /> _ � 2 Screen Screen Length (from)*G,� I Co' F 17c LbWell No.: Z <br /> . pS.f-,,.eS Filter Pack (from) 90- I nc- <br /> Bentonite' (from)l(" ' <br /> Inspector: Grout (from)_ S -'(to) �' <br /> 7�..,.s:4.,., Drilling-rig type- M J P,+�.-- <br /> Permit No. Auger O.D. I Z I.D. <br /> Drilling Company:_ S Cc,c�2. $S to <br /> �0 Completion - Stove pipe istie box (circle one) <br /> Driller:_ S eve, V i 6 barj casing <br /> height <br /> 2 <br /> Consultant A 6i} p�-S • <br /> Geologist S(4,vt 4 PCI L-11 a ie .' <br /> ABOVE-GROUND <br /> bMPLETION C.HRZTY_BOX <br /> SPECIAL PERMIT INFO. QCOMPLETION <br /> rovnd Suriaca <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) <br /> • If yes, location and distance - � • V � ft, <br /> ! ft' <br /> Screen — �A+'1 <br /> SAMPLING C f6 = #3 <br /> �bttad — <br /> IS-0a�caons = ISS ff <br /> Holding Temperature � _ <br /> Method PV c 61,,,4 .ta�k <br /> Screening Method 170 F� 166 f <br /> Tracking Sheet - C y/n) <br /> ZOO <br /> SPOILS <br /> Storage MethodMATERIALS/DEVELOPMENT Z°� <br /> Contamination Noted - (y/n) - ' <br /> Storage Location Casing type A SSS /SVG Sfee <br /> Blank cg-- ff 2�� ft. Screen' ST- <br /> GROUTING <br /> - <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite, e -16 l <F <br /> Depth to water Bags sand/gravel Sa 14 s SLA 3 s <br /> Na Ratios Filter Pack type/size 3 S,,, <br /> Installation Method _ _S.ur e Block:_-_ <br /> Quantity Installed g ( n-)---- -- <br /> Discussed with geologist: - (y/ n ) <br /> EH 29 29 <br /> Type of method <br /> ' <br />