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MONITORING WELL INSTALLATION REPORT <br /> Date:_ f ( S/� CONSTRUCTION <br /> Premise Address:-416'7z r towc� ,est, �rg7�/�P ' Total Depth r <br /> '2Screen Length (from)• 1 20 (to) <br /> Well No.: I w30 - l3'o Filtet Pack (from) It 7..,r (to)_ I 'Yq <br /> J VOA" Bentonite' (from) /I`f -� (to) <br /> Inspector: Grout (from) o (to <br /> Drilling rig type �o 9-T-4RY <br /> Permit No. Auger O.D. 1-o I.D. <br /> Completion- ove pi e christie box (circle one) <br /> Drilling Company: CI�t G& <br /> Driller: iv6 S.4 t— -o%oC cas ing <br /> height <br /> Consultant <br /> Geologist K Rf 41L66t4-j ,w <br /> ABOVE-GROUND <br /> CoYFLEf10N GNRISTY-BOX <br /> SPECIAL PERMIT INFO. Gmund Surixs COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) 1� �- <br /> If yes, location and distance - ft• <br /> 7. <br /> l ` ft. <br /> Y"; = m <br /> _ C <br /> SAMPLING — o <br /> ' slo ttad :; <br /> • aacion = • <br /> Holding Temperature <br /> Method — Gni pack <br /> Screening Method <br /> Tracking Sheet - (y/n) _ <br /> ft. x 1 ft, <br /> SPOILS <br /> L <br /> Storage Method M_ ATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type <br /> Blank (Zo ft. Screen 7-0 <br /> {t. <br /> Slot size o.. o <br /> GROU ITNG Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 2 ti 6W,6-1 sq vr> <br /> Mix Ratios Filter Pack type/size 7- <br /> //Z <br /> Installation Method Block: <br /> ___(_y_/ <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> EH 29 29 <br /> Type of method <br />