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It. <br />C4-iFISSTY-80X • <br />COMPLEMN <br />Ground Surfacir <br />grout <br />.31 ft. <br />ft. <br />ABOVE-GRCUND <br />CX:3A,PLETiON <br />slon.ad <br />secicn <br />gravs4 pack <br />ft. <br />casing <br />t height <br />MONITORING WELL INSTALLATION REPORT <br />Date: CONSTRUCTION <br />Total Depth Premise Address: <br />Well No.: <br />Inspector: <br />Permit No. <br />Drilling Company: <br />Driller: A).14.74a, <br />Consultant ( <br />Geologist <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 (11 <br />Method 17- r( <br />Screening Method <br />Tracking Sheet -(9/ n) <br />SPOILS <br />GROUTING <br />Depth to water t/ / <br />Mix Ratios 7"-4-/f' e--- <br />Installation Method /0_, <br />Quantity Installed /1 <br /> <br />(from) b <br /> <br />Pack (from) (to)3 <br />Screen Leng <br />97( <br /> <br />Length from) (to) <br />Grout (from) , (to) <br />(to)y Bentonite (from) <br />Drilling rig type <br />Auger O.D. I.D. <br />Completion. Stove pipe/christie box (circle one) <br />MATERIALS/DEVELOPMENT <br />Casing 4 PA/ <br />Blank k ft. Screen 7,0 ft. <br />Slot size 0 ,t) <br />Bags cement <br />Buckets bentonite <br />Bags sand/gravel <br />Filter Pack type/size <br />Surge Block: - ( y n ) <br />Discussed with geologist: - <br />Type of method <br />Contamination Noted- ar)/ n) <br />Storage Location (7 6 <br />Storage Method (\, < <br />EH 29 29