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MONITORING WELL INSTALLATION REPORT <br /> Date: /3 0 �( 3 CONSTRUCTION <br /> Premise Address:_ I 6-7 77 L,A,. Total Depth <br /> Screen Length (from) 0 (to) L _0 , <br /> Well No.: E I,✓-I 0 • E W-I I �,,�� [w-► z11 2 Filtet Pack (from) (to) L r, _ <br /> 0130 Bentei-Ai:e'S-._. (from) K,T (to) ' <br /> Inspector: �D �CGIM Grout (from) 3 (to) S <br /> Drilling rig type_ ' CM Sss FI>i1 Sf�,,, <br /> Permit No. 540066 2 38 Auger O.D. I2 I.D. <br /> Drilling Company:_ <br /> Completion - Stove pipe/chnstie box (circle one) <br /> C�.s C ti��� " <br /> Driller: rt13­ti <br /> casing <br /> height <br /> Consultant n f2 C 14 p I S <br /> Geologist V. <br /> ABOVE-GROUND CNA ISTY-80X <br /> co wLETIO N <br /> SPECIAL PERMIT INFO. GroundSurixs COMPLETION <br /> Distance to sewer line groat <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - ft• <br /> .I T) ft. <br /> — m - <br /> " C <br /> SAMPLING = o <br /> sx90 n = <br /> Holding Temperature <br /> Method — vnv+pack <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> s- <br /> Ll 0 ft. <br /> SPOILS <br /> Storage Method M_ P,TERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type_ Sc 1. L PVC <br /> Blank f v ft. Screen 3c, ft. <br /> Slot size (�. C 112 SI—Les5 Stec t <br /> GROUTING Bags cement <br /> Buckets Vie_ '3 L"' 5 <br /> (S v tL) <br /> Depth to water Bags sand/gravel_ 4 S <br /> Mix Ratios Filter Pack type/size 7-/(,L ,z <br /> Installation Method _ Surge Block:-- <br /> lock:_-_(.Y Ln-)-.----. <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />