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MONITORING WELL INSTALLATION REPORT <br /> Date:_ b J/l y CONSTRUCTION <br /> Premise Address: (6777 HoL,,,?�fwa 17,0c,9 Total Depth 8�0 <br /> Well No.: <br /> 3 3-/7o Screen Length (from)* /6-A (to) 17.5- <br /> Filter Pack (from) l5-S' (to)-400 <br /> r c� Bentonite' (from) /,I- �' (to) iss' <br /> Inspector• _ v.�io/ G <br /> Grout (from) (] <br /> Drilling rig type AGvO r4grw" <br /> Permit No. Auger O.D. G sVr I.D. — <br /> Drilling Company: Completion ove pip chnstie box (circle one; <br /> f n• <br /> Driller: <br /> casing <br /> Consultant <br /> height <br /> �/'� C�OI'S ; <br /> Geologist .^ <br /> ABOVE-GROUND <br /> CO YF LE ICN C•I•R Z7Y-8OX <br /> SPECIAL PERMIT INFO COMPLE ON <br /> C3round Surfxs <br /> line groutDistance to sewer <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - <br /> 9 <br /> SAMPLING o <br /> Holding Temperature = <br /> Method gravBW P--<k <br /> Screening Method = <br /> Tracking Sheet - (y/n) <br /> ft. <br /> SPOILS <br /> Storage Method MATERLALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type_ -rG q Vfp <br /> Blank_ (j'c, ft. Screen ft. <br /> GROUTING Slot size_ 0 2 <br /> Bags cement <br /> Buckets bentonite S— <br /> Depth to water Bags sand/gravel_ !o <br /> Mix Ratios Filter Pack type/size J:P3 <br /> Installation Method <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> EH 29 29 Type of method <br />