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MONITORING WELL INSTALLATION REPORT <br /> 3.s <br /> Date: <br /> <<y� _p 8 CONSTRUCTION <br /> th <br /> Premise Address: 3 Y 3 7 A �r `� Total DepScreen Lngth (from ) (to) <br /> V c ,a w � Filter Pack (from) 1-1,3"1 (to) Y6 <br /> Well No.: !'-Meja- T—A /•� — <br /> Bentonite (from) c6 0- (to) <br /> Inspector: 1'. .n Grout (from) CAj�T 7 vl (to) <br /> Drilling rig type <br /> Permit No. Oi6' ?i Auger O.D. R' <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: / <br /> casing <br /> Driller. L' Y r PiPp � � height <br /> Consultant /J moi— 7 <br /> Geologist Ag0yE-"A0U1y0 <br /> C}RLST Y-3ox <br /> C.;h�L_�i lON CCMP_=,1CN <br /> SPECIAL PERMIT INFO. Gound Surface <br /> gr= <br /> Distance to sewer line plc- 1 <br /> Domestic well on site - (y/ n ) ------fL <br /> If yes, location and distance - �_—fL <br /> SAMPLING <br /> slotted P c <br /> secyon <br /> Holding Temperature �'� ;sv°!Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> IL <br /> SPOILS <br /> Storage Method S MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/(V <br /> Storage Location Blank type �� - Screen ft <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite 7 <br /> gS gm <br /> Depth to water S Ba sand/ vel 2%r z <br /> Mix Ratios � G a�� A-e F�1ter Pack typesize *a PI-) <br /> Installation Method �,e - -*� - /""`S-S,) Surge Block: - (y/(5) 160 <br /> Quantity Installed ti c�a�r � Disused with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />