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MONITORING WELL INSTALLATION REPORT <br /> Date:_O I� (� CONSTRUCTION <br /> Premise Address:_ yi[ Y( WGiW� Total Depth SZ <br /> Well No.: M w ' 3C7 Screen Length (from)' v (to)_ <br /> Filter Pack (from) 3 (to) ?� <br /> Inspector: Bentonite' (from) 32 -(to)-&1-- <br /> Grout <br /> to) 3Grout (from) p (to) 3 - <br /> Drilling rig type i- 151 <br /> Permit No. Auger O.D. ?�" I.D. <br /> Drilling Company:_(..Gc <br /> /)�,s(-'�O(t Completion- Stove pipe/chnstie box (circle one) <br /> Driller: <br /> casing <br /> Consultantheight_ 9 <br /> Geologist <br /> AW VE-t R CUND cNA IST'-box <br /> CoMFLEf1ON <br /> SPECIAL. PERMIT INFO. Grour)d Surface COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - 32 ft- <br /> c.�-O ft ft. <br /> SAMPLING — o <br /> Holding Temperature <br /> Method _ — v2M Pack <br /> Screening Method = <br /> Tracking Sheet (y/n) - — <br /> ✓� tt. -� 50 n- <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type Sri • 40 <br /> Blank 0- oft. Screen -� ft. <br /> Slot size 0.0 Zo <br /> GROUTING Bags cement <br /> Buckets bentonite '2- <br /> Depth <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> EH 29 29 <br /> Type of method <br />