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MONITORING WELL INSTALLATION REPORT <br /> 73Date: ^� CONSTRUCTION <br /> Premise Address:_ (�77/ � wNy Total Depth_ I'I0 <br /> Well No.: <br /> F w ►3 I ^ �U Screen Length (from)' 7-a (to) y 0 <br /> Filter Pack (from) It <br /> Inspector: _ Rth,,, <br /> Bentonite (from) is- —(to)�_ <br /> Grout (from) I (to)�_ <br /> Drilling rig type_ H.11 e.. -sle P, <br /> Permit No. Auger O.D. 10 , L, I.D. <br /> Completion- Stove pipe/chnstie box (circle one) <br /> Drilling Company: rnIg <br /> Driller: Senn casing <br /> height <br /> Consultant_ A 12 G A D-xr <br /> Geologist <br /> ABOVE-GROUND <br /> compLEC{ON C iRZTY-80X <br /> cOMPLEnoN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) I <br /> If yes, location and distance <br /> ft, ft. <br /> SAMPLING — o <br /> elottad — c <br /> saclon _ <br /> Holding Temperature <br /> Method — grzyw Pack <br /> Screening Method <br /> Tracking Sheet (y/n) <br /> ft. w 40 ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type ,Se-4 E10 PVG <br /> Blank 'La ft. Screen 20 ft. <br /> Slot size (5, n 10 <br /> GROUTING Bags cement <br /> Buckets bentonite 1 Sb -(4 1. S <br /> Depth to water Bags sand/gravel_ 1 $ sz-16 Le <br /> Mix Ratios Filter Pack type/size z/,z Sw.dl <br /> Installation Method <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> EH 29 29 <br /> Type of method <br />