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MONITORING WELL INSTALLATION REPORT <br /> Date: \ay. ", Thy�^j CONSTRUCTION <br /> Premise Address: Total Depth 20rJ� <br /> Screen Length (from)' \-IGS �a,,s (to' <br /> Well No.:_F—\tlf-\rPJ Filter Pack (from) <br /> (04:,' (to) ` <br /> < Bentonite; (from) l(.? (to)- <br /> Inspector: - �G@�P1i 5d+ Grout (from) (to) <br /> Drilling rig type MX, )r rv(5a ry <br /> Permit No. Auger O.D. t2!' (11*5/dr") I.D. <br /> Drilling Company:' <br /> Completion- Stove pipe/ stie box circle one) <br /> ��� <br /> Driller: Nam Moc�v��s,� casing <br /> height <br /> Consultant <br /> Geologist n2z Va�c� T <br /> ABOVE-GROUND C4iAI5TY-80X <br /> SPECIAL PERMIT INFO. Ground Surface COMPLETION <br /> 5 <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance ;' X02 n• <br /> ti'• m <br /> ' � O <br /> SAMPLING = <br /> Holding Temperature <br /> Method % — gnvW Pack <br /> Screening Method = <br /> Tracking Sheet - (y/ <br /> 20E) tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (,y/n) <br /> Storage Location_ % Casing type P'yC- <br /> Blank_ 1` E� ft. Screen "3C) ft. <br /> Slot size c�.vlc� <br /> GROUTING Bags cement <br /> - t <br /> Depth to water �S Bags�a�d�'gravel_ 3 r-aU-k10 \. s <br /> Mix Ratios Filter Pack type/size # 2/l2 <br /> Installation Method -Surge Block:-- <br /> Quantity <br /> lock•--Quantity Installed Discussed with geologist: - n ) <br /> EH 29 29 Type of method <br />