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MONITORING WELL INSTALLATION REPORT <br /> Date:__ /17- 3 CONSTRUCTION <br /> 1SWelPremise Address:_«777 Ft9ti,L�.•-i� �'9d�d/Zor Total Depth 615- <br /> Well <br /> l No.: PC..-.3 0 8 Q Screen Length (from)' 70 (to) 5) <br /> Filtet Pack (from) 6­7 (to) 91-s- <br /> Inspector: Bentonite' (from) -F,-.) <br /> (to) 61 ? <br /> Grout (from) c-> <br /> Drilling rig type_ <br /> Permit No. Auger O.D. o I.D. <br /> Completion ye i /christie box (circle one) <br /> Drilling Company: G'1{0GG D/?/aeAi(T <br /> Driller:_}_ _fdZoj2,44 casing <br /> height <br /> Consultant �/�LpQOIf <br /> Geologist l4_ <br /> ABOVE-GROUND <br /> COMPLETION GJ{A1STY-BOX <br /> SPECIAL PERMIT INFO. Ground SurfacCOMPLETI ONe <br /> Distance to sewer line -3 <br /> Domestic well on site - (y/n) o <br /> If yes, location and distance - <br /> ZO ft4577 <br /> ft. <br /> SAMPLING = <br /> taction <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> r <br /> ---Q—n• s it. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type SaO 4ff P,✓� <br /> Blank_ —Z2 ft. Screen <br /> Slot size 010 <br /> GROUTING Bags cement <br /> Buckets bentonite I `{. S- <br /> Depth to water Bags sand/gravel Z 5- <br /> Mix <br /> Mix Ratios Filter Pack type/size <br /> Installation Method <br /> Quantity InstalledDiscussed with geologist: - (y/ n) <br /> EH 29 29 Type of method <br />