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casing <br />height <br />C4-iAISTY-80X <br />COMPLETION <br />ABOVE-GROUND <br />COMPLETION <br />Grourxi Surface <br />grout <br />OL,` ft ft. <br />MONITORING WELL INSTALLATION REPORT <br />Date: <br />Premise Address: Address: 3e) 52_ k)oi-srz-e1-5-r-D <br />Well No.: <br />Inspector: <br />Permit No. kf te'ef,(/'97 <br />Drilling Company: *I- 101-1-A— 41 AA 414'mcc/v7J <br />/14(.64,4,, <br />Consultant 464s, <br />Geologist 4)(14,-,t/ITArt <br />SPECIAL PERMIT INFO. <br />Distance to sewer line <br />Domestic well on site - ( y / n ) <br />If yes, location and distance - <br />SAMPLING <br />Holding Temperature <br />Method <br />Screening Method <br />Tracking Sheet - ( y / n) <br />SPOILS <br />Storage Method <br />Contamination Noted Noted - ( y 0) <br />Storage Location <br />GROUTING <br />Depth to water <br />Mix Ratios <br />Installation Method -r et-o.lie <br />Quantity Installed _44. <br />CONSTRUCTION <br />iD6 <br />Screen Length (from) Ta (to) loo <br />Filter Pack (from) 57 ( (to) 1 0 0 <br />Bentonite (from) 2ff- ( (to) ,5? 7 / <br />Grout (from) D • 5 (to) E, / <br />Drilling rig type C ME. <br />Auger O.D. Ir'71) I.D. S— I <br />Completion - Stove pipe (circle one) <br />MA i hRIALS/DEVELOPMENT <br />Casing type PQ C. <br />Blank ctO ft. Screen /0 ft. <br />Slot size O. OZ_ <br />Bags cement (,- — — <br />Buckets bentonite / — <br />Bags sand/gravel 1 — eig <br />Filter Pack type/size 71 3 <br />Surge Block: - (6)/ n) <br />Discussed with geologist: - (6) / n) <br />Type of method .5 ct e <br />Total Depth <br />EH 29 29