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MONITORING WELL INSTALLATION REPORT <br /> Date: 71201 CONSTRUCTION <br /> Premise Address: z � t Total Depth �S <br /> Screen Length (from) (to) <br /> Well No.:S/3 5&L 5133 Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: ��K �-� P Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> �/ <br /> Driller: casing <br /> / _f + height <br /> Consuls L���4� <br /> Geologist ... <br /> /1BCVE-GACUND <br /> CO NFLETCN C>�W fSTY-c30X <br /> COMPLETICN <br /> SPECIAL PERMIT INFO. Grind Sumacs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - <br /> • ft. <br /> fi. <br /> SAMPLING — <br /> •lor.ad E <br /> i� <br /> Holding Temperature_ 7" _ gnYlw Pack <br /> Method V74 _ <br /> Screening <br /> Method' N " _ <br /> Tracking Sheet - (Lj/'n ) r" _ <br /> SPOILS A-k-)�_ <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y <br /> Storage Location Casing type �4'A <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water b 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 />