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MONITORING WELL INSTALLATION REPORT <br /> Date: �/ rj <br /> CONSTRUCTION <br /> Premise Address: ZZo A�� Total Depth 1 <br /> Screen Length (from) 7 (to) /9 <br /> Well No.: A 6 Filter Pack (from) 5 (to)_ el <br /> Bentonite (from) 3 (to) 5 ' <br /> Inspector: Grout (from) O (to) 3 ' <br /> Drilling rig type C4J 95 <br /> Permit No. Auger O.D. Z oil I.D. <br /> Completion < tov /christie box (circle one) <br /> Drilling Company:_T/157upE <br /> Driller: �O R Y / casing <br /> / ?j height <br /> Consultant 1.��'f =7 T <br /> Z• <br /> Geologist PIU <br /> ABOVE-GROUND <br /> COMPLETION CHR*7Y-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line /v grout <br /> Domestic well on site - (y/n 7 ft. 3' <br /> If yes, location and distance - ,d <br /> ' ft. <br /> s <br /> �- O <br /> C <br /> SAMPLING = a i <br /> slcttad _ 2 �2 <br /> ' (�� saclon <br /> Holding Temperature <br /> graack <br /> Method `s t <br /> Screening Method _ <br /> Tracking Sheet (y/ n) _ <br /> 7 <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type SCA. YID PVC— <br /> Blank ---I- ft. Screen 10 ft. <br /> Slot size d.O et D <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 'Z: <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />