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MONI'T'ORING WELL INSTALLATION REPORT <br /> - 41 CON STRUCTION <br /> Date: <br /> 3Y 7 A� , Total Depth /�S to /J <br /> Premise Address: Screen Length (from) 5 ( ) <br /> S (to) v 0 <br /> Filter Pack (from) '- <br /> Well No.: Bentonite (from) !G O (to) 1L — <br /> Grout (from) (to) <br /> Inspector. Drilling rig type <br /> Auger O.D. /0 I.D. / '/J <br /> Permit No. Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> �� -� ,�o casing <br /> Duller: " height <br /> Consultant i/c�-� <br /> C 4--' <br /> L <br /> "L ABOVE-GROUND <br /> 0Ckq#` � _�i <br /> T10N plCN <br /> Ground surface <br /> SPECIAL PERMIT INFO. grout <br /> Distance to sewer line T n- <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - <br /> — S <br /> v% <br /> SAMPLING <br /> soon <br /> r 72VW Pack <br /> Holding Tempera " "— <br /> Method <br /> Screening Metho <br /> Tracking Sh - (y <br /> SPOILS <br /> MATERIALS/DEVELOPMENT <br /> p D <br /> Storage Method <br /> Contamination Noted - (y/D Casing type <br /> Storage Location Bl ft- Screen a O f <br /> Slot size a <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water `� Filter Pack typesize <br /> Mix Ratios %� -Surge Block: - ((?/ n) <br /> installation Methodn <br /> �Ra_ � Discussed with g ogis Y/ ) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />