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MONITORING WELL INSTALLATION REPORT <br /> Date:_ �/' 3 CONSTRUCTION <br /> Premise Address:_1077 [�,,a.c�f,�, �ATNRaP Total Depth <br /> Well No.: <br /> �tni3 Z_ f g� Screen Length (from)' 170 (to) /S0 <br /> Filter Pack (from)_ /,{ 7 (to) / ?J- <br /> Inspector: Bentonite (from) 15-0 (to) /6 7 <br /> Grout (from) (to) /t-- <br /> Drilling rig type /vc vG 2 Zs <br /> Permit No. Auger O.D. to" I.D. <br /> Completion- Stove pipe/ • stie o (circle one) <br /> Drilling Company: �RF66 d�/<</�I/.� <br /> Driller:_ 4A,&'64 9c.4 z jtz <br /> casing <br /> Consultant 149 C,0700' <br /> Geologist L4_ AF,*-t -Ap 1. 7 <br /> ASO VE-GROUND <br /> COMPLETION CNAIM43OX <br /> COMPLETI ON <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line gyxat O�•-3 a- �� <br /> Domestic well on site - (y/n) o f� <br /> If yes, location and distance - ft. <br /> 1.70 ft <br /> • m <br /> vs C • <br /> SAMPLING = s <br /> • sac�on = <br /> Holding Temperature = <br /> VAVW Method = xk <br /> P <br /> Screening Method ' <br /> Tracking Sheet - (y/n) <br /> ! 17-SL- <br /> SPOILS <br /> s'SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type Sc el `d we- <br /> Blank / 70, ft. Screen 2 D ft. <br /> Slot size o t n <br /> GROUTING Bags cement <br /> Buckets bentonite !q <br /> Depth to water Bags sand/gravel 2 <br /> Mix Ratios Filter Pack type/size -tF 2 / Z <br /> Installation Method _..._S.urge.Block:___(.y_/�_____ <br /> Quantity Installed Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method <br />