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MONITORING WELL INSTALLATION REPORT <br /> Date: s CONSTRUCTION <br /> r <br /> Premise Address:_. Al- rQ I L��OZi_ /�/�,�( Total Depth 100 <br /> Screen Length (from) (to) l 0 p <br /> Well No.: Filter Dark (ho ) S6 (to) 1 uD <br /> Inspector: Bentonite (from) g b (to) $'R <br /> P Grout (from) g Lv (to) V <br /> Drilling rig type_ q 5 <br /> Permit No. Auger O.D. ,Z I.D. <br /> r , _ P Completion - Stove pipe/ s e fox one) <br /> Drilling Company:_ l <br /> Driller:_ 1 '�r- 1 casing <br /> / 4 height <br /> Consultant (2 <br /> Geologist kAA/ (,�{w�o��� ,.. <br /> ABOVE-GROUND <br /> CO WP LETC N CHR ISTY-BOX <br /> SPECIAL PERMIT INFO. Ck�xjnd Suixa COMPLETICN <br /> Distance to sewer line grout �g6 <br /> Domestic well on site - y n ) <br /> If yes, location and distance - H. <br /> a <br /> = o <br /> = m <br /> SAMPLING — o <br /> slotted — c <br /> 10 <br /> sx�cn = <br /> Holding Temperature = <br /> Method <br /> Screening Method = <br /> Tracking Sheet - (y/n ) _ <br /> ft. `= = IFft <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type V VG <br /> Blank C(O ft. Screen_ <br /> Slot size D-0 <br /> GROUTING Bags cement <br /> Buckets bentonite iAdc�.T� <br /> Depth to water Bags sand/gravel_ <br /> Mix Ratios Filter Pack type/size -9 ,3 <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> EH 29 29 Type of method <br />