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MONITORING WELL INSTALLATION REPORT <br /> Date:_ 6' /�3/I L� CONSTRUCTION <br /> Premise Address: I9-777 (1c,i,.�,�,� �pqp �•9TMRD%�,.q_ Total Depth 13o <br /> Well No.: �w33 _�z Screen Length (from)' // s (to)_ 1 <br /> _ Filtet Pack (from) It z.S <br /> Bentonite (from)_ /o B (to)1/2.S— <br /> Inspector: �� nyt� Grout (from) (to) !o <br /> Drilling rig type /.-1 Up <br /> Permit No. Auger O.D. C:7 I.D. <br /> Completion- S e pip /christie box (circle—one, <br /> Drilling Company:_ 61���6 pfd/�L! (, <br /> Driller: <br /> casing <br /> Consultantheight_�,p�,�/s ; <br /> Geologist -w <br /> ABOVE-GROUND <br /> ccwLETICN C-iRZ Y-80X <br /> SPECIAL PERMIT INFO COMPLETioN <br /> Ground Surfx-a <br /> Distance to sewer line grafi <br /> Domestic well on site - (y <br /> If yes, Iocation and distance - h- <br /> SAMPLING = o <br /> s to Clad - — c <br /> Holding Temperature = <br /> Method gnvW pack <br /> Screening Method — <br /> Tracking Sheet - (y/ <br /> SP OILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) - <br /> Storage Location Casing type Sett ss,o perV G <br /> Blank LLT-- ft. Screen___L0 0 ft, <br /> GROUTING Slot size O Z.o <br /> Bags cement <br /> Buckets bentonite (. S <br /> Depth to water Bags sand/gravel- <br /> Mix Ratios Filter Pack type/size3 <br /> Installation Method <br /> Quantity Installed Discussed with eologist: - (y/ n) <br /> EH 29 29 Type of method <br />