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MONITORING WELL INSTALLATION REPORT <br /> Dater /y CONSTRUCTION <br /> Premise Address:_ 900 W (,„ S f Total Depth_ 6-1 �f <br /> Screen Length (from) 5 T <br /> Well No.: n►I�W-5 [3 Filter Pack (from) <br /> �,t Bentonite (from) 53 S(to) S <br /> Inspector: ,�o���M "/cam kcf Grout (from) (to) SS <br /> L S RvU�q D�5 Drilling rig type AA r I M /1 <br /> Permit No. (o�0� / Auger O.D. lc S I.D. y. S <br /> Completion ove hristie box (circle one) <br /> Drilling Company: (���,g - pi <br /> ji <br /> Driller: Ja Sov% Ne casing <br /> height <br /> Consultant t,. <br /> Geologist Tihv,,, Sw,111, $orc�oh �uknn <br /> ABOVE-GROUND <br /> COMPLETION CNRtM-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line Grp <br /> Domestic well on site - (y/nN 1 r <br /> If yes, location and distance - ft. <br /> 5 �S n• <br /> ft. <br /> SAMPLING <br /> Clotted c <br /> s c5on — <br /> Holding Temperature = P <br /> awk <br /> Method — <br /> Screening Method .= <br /> Tracking Sheet - (y/n) _ <br /> IFft. <br /> SPOILS <br /> Storage Method h- W j2/e. MATERIALS/DEVELOPMENT <br /> Contamination Noted : (y/a) <br /> Storage Location Oh-Side Casing type S c1 10 P V G <br /> Blank 0 ft. Screen /0 ft. <br /> Slot size 0.0-20 <br /> GROUTING Bags cement /9 <br /> Buckets bentonite / <br /> Depth to water J S Sr-I- Bags sand/gravel <br /> Mix Ratios] X 4-1 A b,as Ire, Sn gals Filter Pack type/size43Sav, <br /> Installation Method u Surge Block: - (y/( <br /> Quantity Installed 't 13U J Discussed with geologist: - & n) <br /> EH 29 29 <br />