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MONITORING WELL INSTALLATION REPORT <br /> Date:_ 14 2-113 CONSTRUCTION <br /> Premise Address:16 777 [fiv" o9.42 Total Depth S <br /> Screen Length (from)_ <br /> Well No.: /P�-✓30-2c Filter Pack (from) <br /> Bentonite' (from) t S' <br /> Inspector: Grout (from) n (to) !,5— <br /> Drilling rig type .�u� /�i/on.t' <br /> Permit No. Auger O.D. tw'` I.D. <br /> ktto_ve pipe 'elu-istie box (circle one) <br /> Drilling Company:_6K�G Completion-O,el�c,/„�� <br /> Drillez: '4 casing <br /> I T <br /> height <br /> Consultant// A�>Cl� <br /> Geologist C6- <br /> ABOVE-GROUND <br /> compLET10N CJ{RISTY-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line Drocrt <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - <br /> ft. <br /> z ftft. <br /> — m _ <br /> •i?. O <br /> • O <br /> ' � r <br /> SAMPLING - o <br /> • sac�on a:• — •� <br /> Holding Temperature = <br /> Method = grays4 pack <br /> Screening Method "{ <br /> Tracking Sheet (y/n) ' <br /> tt. — I Fft. <br /> SPOILS <br /> Storage Method M_ ATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type Serf 4_e7 /jam C, 2 <br /> Blank 2-o ft. Screen -Z oft. <br /> Slot size o <br /> GROUTING Bags cement <br /> Buckets bentonite Z= <br /> Depth to water Bags sand/gravel 7- 1 <br /> Mix Ratios Filter Pack type/size <br /> Installation Method __ _..... _--_Surge_Block__(-y_/ <br /> Method <br /> Quantity Installed Discussed with geologist: - (y/n ) <br /> EH 29 29 Type of method <br />