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MONITORING WELL INSTAILATION REPORT <br /> Date: Li5 C) I CONSTRUCTION <br /> I <br /> Premise Address: Total Depth 3 <br /> / <br /> Screen Length (from) I o' (to) �?p <br /> Well No.:` 1/L.(��� I T2_ 3 �.j - Filter Pack (from) _(to) o <br /> Bentonite (from) S ' (ro) .- <br /> Inspector. Grout (from) --O (to) s ' <br /> Drilling rig type -- <br /> Permit No, C7o r715 `�r Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: k <br /> Driller:_ ._ casing <br /> Ik height <br /> Consultant v <br /> ' 1 <br /> GeoIogisr ABO,_ <br /> VE-GRCJND <br /> COMPLETION C7�iLSTY�OX <br /> CCMPL—MnCN <br /> SPECIAL PERMIT INFO. C3=nd gLrf,cy <br /> Distance to sewer line Qra,i <br /> Domestic well on site <br /> If yes, location and ' ante - - <br /> I <br /> K �. <br /> � . <br /> 4 <br /> is <br /> SAMPLING — o <br /> secicn — <br /> Holding Temperature <br /> Method <br /> _ <br /> Screening Method •3 c ' <br /> Tracking Shcet - (y/ n ) <br /> SPOILS <br /> Storage Method- MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n <br /> LL Storagelocation • _: Casing type Z <br /> BIank i o fr. Screen z o ft. <br /> Slot size 0 Z1 O <br /> GROUTING Bags cement <br /> Depth to water ^' (5 k Buckets bentonite <br /> De N. 3 <br /> P Bags sand/gravcl g- tN <br /> Mix Ratios I Filter Pack type/size -7- 1-z- <br /> Installation <br /> zInstallation Method Surge Block: - <br /> Quantity Installed Discussed with geologist: - (y <br /> EH 29 29 Type of method <br />