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MONITORING WELL INSTALLATION REPORT <br /> Date:_ ����! CONSTRUCTION <br /> Premise Address: 777 (-(�PwL4-o 4_&+r/nc/ Total Depth_ C�S <br /> Screen Length (from)' 7� (to) `I n- <br /> Well No.: ��-✓�3 - p Filter Pack (from) 6 z-S (to) 9 s <br /> Inspector• <br /> Bentonite' (from) G s' (to)_L7 s <br /> ' <br /> Grout (from) D '(to) CY s— <br /> Drilling rig type_ �i� 20;sf�4 y <br /> Permit No. Auger O.D. to ` I.D. <br /> Drilling Company:_ Ic«wG --- <br /> Completion- Stove pipe/ sqe bo circle one) <br /> fR�G< OR <br /> Driller:_ <br /> casing <br /> Consultant /2- S height <br /> Geologist f i_ At.vLZ1A,) ._ <br /> ABOVE-GROUND <br /> COh,PLE ;CN C�iA1STY-80X <br /> SPECIAL PERMIT INFO. COMPLETION <br /> Ground Surface <br /> Distance to sewer line Drout <br /> Domestic well on site - (y/n) �Y > <br /> If yes, location and distance - ft. <br /> � 7Sr .ft. <br /> 7o ft. <br /> m <br /> SAMPLING — D <br /> Holding Temperature <br /> Method — P. <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> C7 ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type_ Sc Ll ,�✓G Lt <br /> Blank 20 ft. Screen Zo ft. <br /> Slot size O. of <br /> GROUTING Bags cement <br /> Buckets bentonite Z <br /> Depth to water Bags sand/gravel_ �Y <br /> Mix Ratios Filter Pack type/size #7- <br /> Installation <br /> Installation Method Surge-Block: <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> EH 29 29 Type of method <br />