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MONITORING WELL INSTALLATION REPORT <br /> Date:_ o'� PC) I LI CONSTRUCTION <br /> Premise Address:_ `b00 C-t-)"rc -, Slr .lei --'�,[o k4o,,, Cif Total Depth <br /> _ , Screen Length (from) (to) <br /> Well No.: �h/ Filter Pack (from) (to) <br /> v Bentonite (from) (to) <br /> Inspector:775 e Grout (from) (to) <br /> Drilling rig type M c. , �v <br /> Permit No. Auger O.D. I.D. k <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: (hleiS casing <br /> height <br /> Consultant <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION C#�RIS'TY=80X <br /> SPECIAL PERMIT INFO. Ground Surface COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - n- <br /> ft. ft. <br /> — m <br /> = r <br /> — c <br /> SAMPLING = <br /> slotted — <br /> sac7on — <br /> Holding Temperature Ort- <br /> Method co ' ;Pies; _ P <br /> Screening Method IDa3O <br /> Tracking Sheet - n) -wt — <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Qn Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/n) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />