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MONITORING WELL INSTALLATION REPORT <br /> Date: Ik \`\1 5 h CONSTRUCTION <br /> Premise Address-. 1 15 b a'(, Total Depth is <br /> Screen Length (from) •s (to) IS,I <br /> Well No.: YV\CA)- Filter Pack (from) —(to) Is <br /> Bentonite (from) z (to)_ _ <br /> Inspector. 11 AAnrQh Grout (from) -9- (to)— <br /> to) z <br /> Drilling rig type <br /> Permit No. O ( ZZ Auger O.D. 2k' I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: I1�4m."A <br /> Driller: TO VVI rAJLIJcccasing <br /> height <br /> Consultant IV� <br /> Geologist (a i 2 4 ce, w' 1 .k A�� _ r[r[////�� T <br /> ABOVE-GRCCRJD CRAM-BOX <br /> COh1PLETION CCMPLRICN <br /> SPECIAL PERMIT INFO. G=rd Svrl'a <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) It. <br /> If yes, location and distance - ft- <br /> _ o <br /> SAMPLING slorui <br /> socicn <br /> Holding Temperature �kA 'I CA - �, �Pack <br /> Method L"ls rnn aleo,, <br /> a <br /> ScreeningMe[hod Pik-) o {z-ev. <br /> Tracking Sheet - ( y/ n ) <br /> �1Lft. _ ft <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type 7-" PVC`_ <br /> Blank S fL Screen IO ft. <br /> Slot size •020 <br /> GROUTING Bags cement <br /> Buckets bentonite cli V22 <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size z ti 1ow .� <br /> S6%, Sc. . <br /> Installation Method n -� 4k, 3 ' Surge Block: - t� n ) <br /> Quantity Installed nT " .r (L.,�..�, Discussed with geologist: - (y/M) <br /> Type of method <br /> EH 29 29 <br />