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MONITORING WELL INSTALLATION REPORT <br /> Date:_ �'�3�� CONSTRUCTION <br /> Premise Address: 16777 tfvui f,4g> pv4A c Tb�Rc,P Total Depth <br /> Well No.: l�w 3 C—/ 70 Screen Length (from)• i 7 o (to) l `'l O <br /> Filter Pack (from) VG 7 (to)__L2_C <br /> Inspector: _ J•*R42 Bentonite' (from) I 12 (to) lue-7 <br /> Grout (from) i i Y � (to)�_ <br /> Drilling rig type ;4 -v A-7,4/t 1' <br /> Permit No. Auger O.D. I.D. <br /> Completion tove pi /ch'stie box (circle one) <br /> Drilling Company: 6_A, 46 p/c/c 4 i v6 . <br /> Driller:_ 1,(164 !A4c g7,e2 <br /> casing <br /> B height <br /> Consultant <br /> Geologist /<- /�E.y�v,�/� .� �► <br /> ABOVE-GROUND <br /> cowFLETIUN C}iA15'7 4= <br /> SPECIAL PERMIT INFO. Grwr)d Suiace COMPLETION <br /> Distance to sewer line <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - ft. <br /> — m _ <br /> C <br /> SAMPLING = o <br /> slotted = S <br /> soon = <br /> Holding Temperature <br /> Method Viva?Pack <br /> Screening Method _ <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type 510 'tv 014,"1 <br /> Blank f ?O ft. Screen__2o ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite i y <br /> Depth to water Bags sand/gravel 2�i' <br /> Mix Ratios Filter Pack type/size J"r Z 1/Z <br /> Installation Method _ -Surge_Block:_-_(.y_/ <br /> Quantity Installed Discussed with geologist: - (y/n ) <br /> EH 29 29 <br /> Type of method <br />