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MONITORING WELL INSTALLATION REPORT <br /> Date: CJ� 2 CONSTRUCTION <br /> Premise Address:_ 112/C 44 Total Depth S 0 <br /> Screen Length (from) .0 (to) - <br /> Well No.: J') ( Filter Pack (from)2(,,S (to) y b <br /> Bentonite (from)_ ;Z 3- G (to) G <br /> Inspector: J, o � Grout (from) ,23-6 (to) .s--e$4& <br /> Drilling rig type 6(,o(2Qo& 7P22 n7' <br /> Permit No. ��� ej y0 Z Auger O.D. Q, I.D. <br /> 4f- <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: N I <br /> Driller: ` casing <br /> Consultant ��LC i�� h2 <br /> 1 height <br /> Geologist <br /> ABOVE-GRCUND <br /> WX <br /> CCWFL.Er{ON Ct{CCMPtEPLE TICNCN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line N groin <br /> Domestic well on site - ( y/ n ) <br /> B' <br /> If yes, location and distance - <br /> ft. <br /> ft. <br /> A <br /> - C <br /> SAMPLING Maned = c <br /> Holding Temperature <br /> Method <br /> Screening Method —_ <br /> Tracking Sheet ( y/ n ) — <br /> ft. <br /> — tt. <br /> SPOILS <br /> Storage Method D�xS MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) ' V <br /> Storage Location Casing type L <br /> Blank G - ? D ft. Screen 30- <br /> Slot size O l U <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 30 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />