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MONITORING WELL INSTALLATION REPORT <br /> Date: /D L'��"I o/ / CONSTRUCTION <br /> Premise Address: /U/ Total Depth -.I/&/) <br /> s }o— g / V W7 Screen Length (from) 15 (to) 35 <br /> Well No : ( Filter Pack_ (from) /3 (to) _ <br /> Bentonite (from) // (to) /3 <br /> Inspector: 1�G f+_ Grout (from) / (to) <br /> Drilling rig type ,41/0 <br /> Permit No. 5R 00 Auger O.D. 8' __I.D. q <br /> Drilling Company: <br /> Completion- Stove pipe/christie box (circle one) <br /> �� <br /> Driller: casing <br /> Consultant height _EWT <br /> /l <br /> Geologist <br /> ABOVE-GROUND CNRtm-BOX <br /> COMPLEfX)N COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sumacs <br /> Distance to sewer line gram <br /> Domestic well on site- (y/n) <br /> If yes, location and distance - ft' <br /> ft. <br /> ft. _ <br /> o <br /> e <br /> T. <br /> — <br /> SAMPLING sbttad = c <br /> &#cion <br /> Holding Temperature <br /> gr&vq'Pack <br /> Method <br /> Screening Method yg <br /> Tracking Sheet - (y/n) <br /> ft. = ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) 2 /�C <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size C1� <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 7%L d'.2s 9t3 :?�c/J <br /> Mix Ratios PI =0 Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> EH 29 29 of f-1 k,e f�0 W — ML Type of method <br /> 5 - /„kt6l '6)dv'YV P46 ZS <br /> -321 SID : ZS <br />