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MONITORING WELL INSTALLATION REPORT <br /> Date: 7 y' 2 CONSTRUCTION <br /> Premise Address:_ /U/o <�-C-Pftg2 Total Depth SS <br /> Screen Length (from) _k) (to) Sd _ <br /> Well No.: NI w Z Filter Pack (from) (to) $S <br /> Bentonite (from) 571 <br /> Inspector: -.6 tg-,,wj _ Grout (from) (to) Uf <br /> Drilling rig type 6-ea R&3F <br /> Permit No. Si�ckG� Auger O.D. IF I.D. <br /> LI- Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: (roP2ot3F <br /> Driller: J��/ casing <br /> height <br /> Consultant k� �►y�1p'fP <br /> Geologist 7F <br /> ABOVE-GROUND <br /> CCMPLETCN CNAISTY 8OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line N (a grout <br /> Domestic well on site - ( y/ n ) , ft Z z <br /> If yes, location and distance - <br /> 4 n. ft.Z,?/, <br /> a <br /> O <br /> C <br /> SAMPLING ��o ttad <br /> Holding Temperature = �� <br /> Method = " <br /> Screening Method - <br /> Tracking Sheet ( y/ n ) <br /> ( l <br /> ft. 3 tt. <br /> SPOILS a"+&,e <br /> Storage Method l��c�w1 MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/C&)) <br /> Storage Location Casing type �U C <br /> Blank 30 ft. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite 6Sts 4 8 S 206c40 <br /> Depth to water 1 go Bags sand/gravel_ / (To <br /> Mix Ratios Filter Pack type/size s9 —*j <br /> Installation Method Surge Block: - ( y/G) <br /> Quantity installed Discussed with geologist: - ( y/ <br /> Type of method -i <br /> EH 29 29 <br />