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MONITORING WELL INSTALLATION REPORT <br /> 6 Q)F— 6_ <br /> Date: 3 J CONSTRUCTION <br /> Premise Address: 1 to Total Depth 10,7 <br /> Screen Length (from) 0 (to) <br /> Well No.: /l l(� �� Filve pack (from) /87 (to) <br /> Bentonite (from) (to) $S <br /> A4=to) <br /> Inspector: Vuldri 6– Grout (from) <br /> Drilling rig type <br /> Permit No. Sg- �p/� Auger O.D. '7I.D. <br /> / � � Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:_�-�4-'SG�'A� <br /> Driller: /p►Z/ '�(—"'� casing <br /> height <br /> Consultant__ /Tll <br /> Geologist__ i <br /> ABOVE-GROUND 7a, <br /> COM?LETON CHAJST 4= <br /> SPECIAL PERMIT INFO. G=nd Suixa COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) !j <br /> If yes, location and distance - ft. <br /> 74 ft. <br /> _= m <br /> b <br /> m <br /> SAMPLING slatted <br /> avc5on <br /> Holding Temperature <br /> Method gni pack <br /> Screening Method <br /> Tracking Sheet - (y/n ) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type Pyc, <br /> Blank ;L ft. Screen <br /> Slot size <br /> GROUTING Bags cement_ 50 X 7 <br /> Buckets bentonite <br /> Depth tow er Bags sand/gravel <br /> Mix Ratio Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> EH 29 29 Tyvt ��� Type of method <br />