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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: �G�{v( &4*545Eougd> 63 Total Depth 15 <br /> n 'I Screen Length (from) (to) /T <br /> Well No.: r '1 Filter Pack (from) (to) /Ir,7 <br /> Bentonite (from) 7 (to)78— <br /> Inspector: Grout (from) Z (to) S <br /> Drilling rig type1E�-►++ i., v�l� LA! <br /> Permit No. �G 3[� Auger O.D. I.D. <br /> Completion - Stove pipe/chiistie box (circle one) <br /> Drilling Company: <br /> Driller: NICK (r(Zf}►VD casing <br /> height <br /> Consultant �t5 E,V&4Mi46,41U- <br /> Geologist da3, ' •- <br /> ABOVE-GROUND <br /> CCNPLETICN CNAISTY4 X <br /> COMPLETICN <br /> SPECIAL PERMIT INFO. Ground Surfaco -- <br /> Distance to sewer line ' " grout <br /> Domestic well on site - (y/ n ) -7 ft <br /> If yes, location and distance - Q, <br /> 1 <br /> ft. ft. <br /> a <br /> = m <br /> _ m <br /> C <br /> O <br /> SAMPLING r� �lottad <br /> �� aeon _ Sri P <br /> Holding Temperature l / <br /> y _ <br /> Method — <br /> Screening Method = <br /> Tracking Sheet ( y/ n ) <br /> ft. ft. <br /> SPOILS <br /> Storage Method 4330'-o MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) L <br /> Storage Location Casing type <br /> Blank ft. Screen <br /> Slot size e ri <br /> GROUTING Bags cement <br /> K Buckets bentonite <br /> Depth to water n. �' Bags sand/gravel <br /> Mix Ratios W197- Filter Pack type/size <br /> Installation Method Surge Block: - (y I<L� <br /> Quantity Installed Discussed with geologist: - ( y/ <br /> Type of method <br /> EH 29 29 <br />