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MONITORING WELL INSTALLATION REPORT <br /> Date: (� - CONSTRUCTION <br /> Premise Address: Total Depth I r <br /> Screen Length (from)'I(-) l �2Q (to) c) 1 <br /> Well No.: �M- Filter Pack (from) (,-I f 1\-1 <br /> Bentonite' (from) 1U�v <br /> Inspector: _ J, `1'ot6' in. -� Grout (from) �2 (to) _ <br /> SRS �v d Drilling rig type t,;y cX rSt a r•� <br /> Permit No. -Gw (ol-(A Auger O.D. t? " I.D <br /> Drilling Company:_ �y¢fjCr�, jj � . <br /> n Completion- Stove pipe/ stie box (circle one) <br /> Driller: c casing <br /> height <br /> ConsultantC�Cp� V rA �, <br /> Geologist_��v�dnY�V��3�i�3 ._ <br /> ABOVE-GROUND G�iAJS7Y-BOX <br /> comPLE-r ON <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - ft• <br /> SAMPLING _ o <br /> elottad <br /> tx-lon _ 2 <br /> Holding Temperature <br /> Method — g"V91 Pack <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> lCK)Ar)0 ft, <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type_ (erg PVC <br /> Blank c� ft. Screen 3Ca/�_ft. <br /> Slot size o,o to -JotA-1 <br /> GROUTING Bags cement <br /> Buckets bentonite l'?) (cif. E4\n1ejlu5 <br /> Depth to water ."ABags gravel <br /> Mix Ratios �(trn5, Filter Pack type/size '42/t,2 w.ev��Prtxn <br /> Installation Method __ "�� _._ _Surge Block: - <br /> Quantity Installed 41 bt6 Discussed with geologist: - Q/ n) <br /> EH 29 29 Aol30 Type of method <br />