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MONITORING WELL INSTALLATION REPORT <br /> Date: 7-Z 7 2 <br /> CONSTRUCTION <br /> Premise Address: �Y acn�,c�� Total Depth � ` <br /> Screen Length (from) (P (to) H?_ <br /> Well No.: h'L�` Filter Pack (from) S- (to) _ <br /> Bentonite (from) (to) 5" <br /> Inspector: yceff-" Grout (from) (to) 3"A <br /> Drilling rig type L401(QZ-9 oddK3 <br /> Permit No. SQA (,S 3(,5Auger O.D. 'X/7/1.1). <br /> Drilling Company: / <br /> /� 0E&& Completion - Stove pipe/c istie box (circle one) <br /> Driller: Mee GAnW casing <br /> height <br /> Consultant A C�,r,,-V5 F r R�/�C <br /> —U <br /> Geologist JOYb dA-->F0 _ 7F <br /> ABOVE-GROUND <br /> CC NP LETIC N CNA ZTY-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line N grout <br /> Domestic well on site - <br /> If yes, location and distance - ft' <br /> � ft. <br /> ft. <br /> — a <br /> — m <br /> q <br /> C <br /> SAMPLING flatted — <br /> a�on <br /> Holding Temperature <br /> Method -' <br /> Screening Method <br /> Tracking Sheet - (Y/ rt ) <br /> 12- _ <br /> ft. — ft. <br /> SPOILS <br /> storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type PUC <br /> Blank 6 ft. Screen <br /> Slot size PR e6jK, ✓)'IfSH <br /> GROUTING Bags cement < <br /> ... Buckets bentonite .!I <br /> Depth to water 5 Bags sand/gravel <br /> Mix Ratios SAT- 0-&r,&AT- Filter Pack type/size <br /> Installation Method too C,Z Surge Block: - ( y/ n <br /> Quantity Installed Discussed with geo ogist: - ( y/Cn)) <br /> Type of method <br /> EH 29 29 <br />