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MONITORING WELL INSTALLATION REPORT <br /> Date:_ �l 101/3 CONSTRUCTION <br /> Premise Address: 4G777 H1>4't—ZAV"> TCto Total Depth `� f <br /> r <br /> Well No.: <br /> J°w 3/—/y O Screen Length (from) 1 (to) `fo <br /> Filter Pack (from) t r (to) / Y-5- <br /> Inspector: Bentonite' (from) l i Z (to) irs <br /> Grout (from) c7� (to) f, a <br /> Drilling rig type Mvr> '00 1- <br /> Permit No. Auger O.D. I I.D. <br /> Drilling Company: <br /> Completion- Stove pipe/ ircle one) <br /> _F�-G' <br /> Drillez:_ 4- _1�9e4 zort/e casing <br /> height <br /> Consultant <br /> Geologist k-. �i✓�v�uC� <br /> ABOVE-GROUND <br /> cUNPLE ION CHA157 4= <br /> SPECIAL PERMIT INFO. COMPLETION <br /> t3round Staiacs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - «Z ft. <br /> SAMPLING — o <br /> slottad = <br /> Holding Temperature 'N <br /> Method — grays?pack <br /> Screening Method = <br /> Tracking Sheet - (y/n) _ <br /> t ft. x = /'��' tt. <br /> SPOILS <br /> Storage Method M_ ATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type o PIC- <br /> Blank <br /> ISBlank 17,0 ft. Screen 2-49 ft. <br /> Slot size o <br /> GROUTING Bags cement <br /> Buckets bentonite Z <br /> Depth to water Bags sand/gravel Z l <br /> Mix Ratios Filter Pack type/size -:eF2- l Z <br /> Installation Method Surge Block:___(-Y-Ln-)-- <br /> Quantity <br /> _y_/n-)__Quantity Installed Discussed with geologist: - (y/ n) <br /> EH 29 29 Type of method <br />