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MONITORING WELL INSTALLATION REPORT <br /> Date:__ CONSTRUCTION <br /> Premise Address: Total Depth 7_C5 <br /> Scraen Length (from)' t- - (to) 1 <br /> Well No.:_LVy�- 1Z (�> Filter Pack (from)_ 1�'c3'�«.5 (to) <br /> Bentonite' (from) <br /> Inspector: c `/ Grout (from) T tof' <br /> p,�,, Drilling rig type N1 ro <br /> Permit No. �(�(y71 Auger O.D. I.D-.-' <br /> Drilling Company: Ca�_ zC(e. <br /> Completion- Stove pipe/chnstie box (circle one) <br /> ��`\moo <br /> Drilled: casing <br /> height <br /> Consultant <br /> Geologistpa <br /> A80VE-GROUND <br /> comPLEf7CN C-8RIM-BOX <br /> SPECIAL PERMIT INFO. COMPLETION <br /> Cirvund Surface <br /> Distance to sewer line grout <br /> Domestic well on site - Cy/n) <br /> If yes, location and distance <br /> = r <br /> SAMPLING — o <br /> Blotted <br /> • Bron = .$ <br /> Holding Temperature = <br /> Method _ _ vivo'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 <br /> Blank_D <br /> Ljb&\tG Screen ft. <br /> Slot size OiO'2o <br /> GROUTING Bags cement <br /> Buckets bentonite -,5 <br /> Depth to water Bags sand/gravel 3-f <br /> Mix Ratios �fJ 4 - tir Oc„�, c'' Filter Pack type/size A2 <br /> Installation Method <br /> Quantity Installed Discussed with geologist: - (y/n) <br /> EH 29 29 ' <br /> Type of method <br />