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MONITORING WELL INSTALLATION REPORT <br /> Date:_ / ���.� CONSTRUCTION <br /> Premise Address: l6 777 rHA0p Total Depth 75– <br /> Well <br /> tWell No.: O Screen Length (from)' (to) /_C/0 <br /> Filter Pack (from) l 6 .7 (to) / �s <br /> Inspector Bentonite' (from) G Y (to) /6 Z <br /> Grout (from) O (to) <br /> Drilling rig type_ .M✓D /'�t;T/J/L }' <br /> Permit No. Auger O.D. l 2 `' I.D. <br /> Completion- Stove pipe/do-stie o circle one) <br /> Drilling Company; 6R��G DR/GLI.v� <br /> Driller: /4 -,f 7_� casing <br /> height <br /> Consultant <br /> Geologist K 2��iL live) ,w <br /> ABO VE-GROUND <br /> COMPLETION GNAISTY-80X <br /> SPECIAL PERMIT INFO. Ground Surface COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) �. C ft.If yes, location and distance - <br /> q <br /> SAMPLING _ o <br /> slatted <br /> sacdon = <br /> Holding Temperature <br /> Method — grays-i Pack <br /> Screening Method _ <br /> Tracking Sheet - (y/n) _ <br /> SPOILS <br /> Storage Method M,1TERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type 5c tf Ir w <br /> Blank_ i 7%2 ft. Screen <br /> Slot size c. O i D <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 2 5- <br /> Mix Ratios Filter Pack type/size -1F7-/;–' <br /> Installation Method_ __._.__._S.urge <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> EH 29 29 Type of method <br />