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MONITORING WELL INSTALLATION REPORT <br /> Date:������ <br /> CONSTRUCTION <br /> ^�- SuyPr t>3X�, �1SriL185 �i•oa/r� <br /> Premise Address: Total Depth <br /> Screen Length (from)' d5o ' (to) dao' <br /> Well No.:_ Ot✓g -asp Filtet Pack (from) (to) dab' <br /> Bentonite (from) aa8' (to) -;VL <br /> Inspector: J,� •-� Grout <br /> (from) aas' (to) o ' <br /> Drilling rig type vor V 10 <br /> Permit No. Auger O.D._ (o'r,, I.D. <br /> Drilling Company:_ Completion -'�pe/chnstie box (circle one, <br /> �� t�h�C� �U <br /> Drillez:_ GfIR/S rr�/s92 <br /> casing <br /> height <br /> Consultant_ '9X6 /J y,J, ,mac. � <br /> Geologist I If g„l -_ <br /> . A50 VE-GROUND <br /> cowLETON CNRISTY 8aX <br /> SPECIAL PERMIT INFO COMPLFnoN <br /> C3rcund Suriaca <br /> Distance to sewer line grout <br /> Domestic well on site - (y <br /> If yes, location and distance - aaS ft, <br /> SAMPLING = o <br /> Ilatted — c <br /> L?c-50r1 ;• <br /> Holding Temperature = <br /> Method <br /> Screening Method — <br /> Tracking Sheet - (y/n) _ <br /> SPOILS <br /> Storage Method MATERLALS/DEVELOPMENT <br /> Contamination Noted - (�j, /n) <br /> Storage Location_ SlM �r �tr�u�o h cHrp� Casing type P sGH QV4- <br /> Blank a3v ft. Screen_,go ft. <br /> GROUTING Slot size o.Da' <br /> Bags cement S7 T <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 13 <br /> Mix Ratios Filter Pack type/size X/L//a -03 <br /> Installation Method ____ _ _Surge.Block: - /n_)__ <br /> Quantity Installed Discussed with eologist: - n) <br /> EH 29 29 Type of method <br />