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MONITORING WELL INSTALLATION REPORT <br /> Date: J CONSTRUCTION <br /> Premise Address: 7i(�l q0 Ohl I Total Depth <br /> ��� 3g Screen Length (from) qO (to)_ ly0 <br /> Well No.: Filter Pack (from) g 9- (to) /U r,> <br /> Bentonite (from) 86 (to) �'& <br /> Inspector: Grout (from) MF O (to) 96 <br /> Drilling rig type Ci►VL_I5 <br /> Permit No. Auger O.D._!" I.D. <br /> Drilling Company: <br /> ��n , ��� Completio - /christie box (circle one) <br /> `A" v pip <br /> l ♦ ' <br /> Driller:_ casing <br /> G�r height <br /> Consultant <br /> Geologist CUl�� <br /> ABOVE-GROUND <br /> COWFLETCN CNRSM_BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. n' Ground Surlace O <br /> Distance to sewer line ��T 0roul <br /> Domestic well on site - (y/ ft. $6 <br /> If yes, location and distance oZ <br /> qvCD <br /> a <br /> m <br /> SAMPLING <br /> / slotted c � <br /> 10 <br /> Holding Temperature _ P <br /> ack <br /> Method <br /> Screening Method = <br /> Tracking Sheet - (y/ n) _ <br /> t vn n• _ ft. 1 o a <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) a <br /> Storage Location Casing type Z p V c <br /> Blank 9'9 ft. Screen 1 o ft. <br /> Slot size__ D ),e)" <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 8 <br /> Mix Ratios Filter Pack type/size - 3 <Z4AI�> <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />