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MONITORING WELL INSTALLATION REPORT <br /> Date: 1A k 6 CONSTRUCTION <br /> c <br /> Premise Address: Total Depth y �� <br /> Screen Length (from) 6 <br /> Well No.:� )MV-V7,2, 4 ti kw-1 3 Filter Pack (from) (to)_g-<_ <br /> Bentonite (from) <br /> Inspector: __ 0A A.rC„y _ Grout (from) <br /> Drilling rig type <br /> Permit No. 3 —�c(Z �w Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> ... <br /> Driller: AA casing <br /> height <br /> Consultant ,L�-!��{ <br /> Geologist --,,, �a, IM111MA .L <br /> ..__ _. ABOVE-GROUND <br /> COWPLE CN CNRfM430X <br /> SPECIAL PERMIT INFO. G=nd Suriws COMPLEf1ON <br /> Distance to sewer line grout <br /> Domestic well on site - <br /> If yes, location and Once - ft. <br /> >•` q <br /> SAMPLING o <br /> �lottsd c <br /> ikon ? = <br /> Holding Temperature _ t tZ f` <br /> Method " M — V'VW Pack <br /> Screening Method [ n ' <br /> Tracking Sheet (y n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (yY0 <br /> Storage Location Casing type_Z " <br /> Blank 6 ! ft. Screen ft. <br /> SIot size 020 <br /> GRQIJIING Bags cement 11— _ <br /> Buckets bentonite f <br /> Depth to water �lJ ' <br /> Mix RatiosBags sand/gravel .v <br /> {,, / ��- Filter Pack type/size o <br /> Installation MethodSurge Block: - n ) <br /> Quantity Installed Discussed with eologist: - ( y <br /> EH 29 29 <br /> Type of method <br /> J - <br />