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MONITORING WELL INSTALLATION REPORT <br /> Date: 'S 0 131 / CONSTRUCTION <br /> •` w TV <br /> Premise Address: )?Pc,,;r &fj Total Depth <br /> Well No.: /�/L(l XScreen Length (from) (to) 3 <br /> 33 Filter Pack (from) (to)a7 <br /> Bentonite (from) 3-7 (to)_ <br /> Inspector: _ ��. we f— Grout (from) (to) d7rm <br /> Drilling rig type <br /> Permit No. �S)Z (�� <br /> Drilling Company:_ 7 b /�`� Auger O.D. '' I.D. <br /> /1 o"'L, Completion - Stove pipe/christie box (circle one) <br /> . <br /> Driller: ! c �2 J <br /> t <br /> casing <br /> 4D height <br /> Consultant <br /> _qEVT <br /> Geologist A� ,_ <br /> — r ABOVE-GROUND <br /> GOWLETION CHAISTY-BOX <br /> SPECIAL PERMIT INFO. G=nd Surface COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - ft. <br /> eft. .3 ft. <br /> _= m <br /> m <br /> C <br /> SAMPLING = <br /> �fottad � <br /> aacton — <br /> Holding Temperature = <br /> Method Pack <br /> = <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method M_ ATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing typeA1C. <br /> Blank tai ft. Screen <br /> Slot size <br /> GROUTING Bags cement X [�? <br /> Buckets bentonite <br /> Depth to wat Bags sand/gravel <br /> Mix Ratios X q1 aLl Filter Pack type/size <br /> Installation Method AS 716ftilf. Surge Block: - (y/ n ) <br /> Quantity Installed /�J jx Y'2 0 &t f 1Q Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />