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MONITORING WELL INSTALLATION REPOn f <br /> Date: `w CONSTRUCTION <br /> Premise Address: �2( ( �G� Total Depth /06 <br /> Screen Length (from) 10d (to) d <br /> Well No.: / �" Filter Pack (from) t>0 (to) — <br /> Bentonite (from) (to) — <br /> Inspector: Grout (from) (to) o <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pip c stie box (circle one) <br /> "" <br /> Driller: /Acf 7- 2, casing <br /> height <br /> Consultant <br /> 4-6,!5 <br /> 7, <br /> Geologist /cL/' •" <br /> ABOVE-GROUND <br /> COWLETION CHRiSTY 80X <br /> SPECIAL PERMIT INFO. J Ground SuTlact <br /> Distance to sewer line grout <br /> Domestic well on site - y n ) F� <br /> If yes, location and distance - �D �Sa 9� ft <br /> \ ZEft. <br /> ft — <br /> so <br /> 0 <br /> r <br /> c <br /> SAMPLING — <br /> o aac�on = <br /> Holding Tempe C— <br /> Method J►-�� — � <br /> Screening Method = <br /> Tracking Sheet - y n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n ) S 41�\ j <br /> Storage Location S i,•J"Gdz^�h -c Casing type <br /> Blank Gj`�t ft. Screen (� <br /> ft- <br /> Slot size . 0 <br /> GROUTING Bags cement N 7� <br /> Buckets bentonite 7e-30 P <br /> Depth to water %�J Bags sand/gravel <br /> Mix Ratios 5 Filter Pack type/size 3 <br /> Installation Method rG" Surge Block: - (y <br /> Quantity Installed Discussed with geologist: - (y <br /> Type of method <br /> EH 29 29 <br /> .�.6� IWI- �7 <br />