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MOMTORING WELL INSTALLATION REPORT <br /> &OA-)G y <br /> Date: - 7 CONSTRUCTION U� / WE u <br /> Premise Address: Total Depth 4 <br /> Screen Lengm (from) R'O' (to) S <br /> =filter Pack (from) ,Va'Iced [s'(to) ��3 <br /> Well No.: Caw 2��/1 � � �rec.� <br /> Bentonite (from) (to) ca i <br /> e, UZ ��" /Ze- ,_ Grout (gym) (to) <br /> r <br /> inspecto - ;� <br /> - �g ng t9De h u „w � <br /> Pe---mit No. n1s- Fr(9 0 Auger O.D. /'y' I.D. <br /> Completion- Stove pipe/earistie box (circle one) <br /> Drilling Company: <br /> Driller: cas�4 <br /> heirhx <br /> Consultant ifs-�a�� _ r T <br /> Geologist /��a� K��` <br /> Jt30VE-.ir�CtJi�ID <br /> SPECIAL P�RNIIT iN O. C,cour�Sc:`xs [ <br /> S gr u 101/L <br /> Dis=ce to sewer line 4 <br /> L4 <br /> 118 V <br /> Domestic well on site - ((:�P/ n) r7 <br /> if yes, locarion and distance - <br /> fro <br /> SAMPLING sloraa w�� <br /> sac,.on Su <br /> Holding Temperature _ <br /> Method <br /> Screening Method-- <br /> i racking <br /> ethodTracking Sheet - (y/ n) <br /> SPOILS <br /> Storage Method ce"111 MAT RIAIS/DEVELOPNENT _ <br /> Contamination Noted - (y n <br /> u Las_ [G.� <br /> Storage Location ��� � c` o� Casing type��vG IL fv l ' <br /> B f` Screen rL skw1 <br /> Slot size <br /> GitOUTTNG Bags cemenr <br /> Buckets bentonite <br /> D ” ' Liz; <br /> Bags sand/gravet/.51#4 <br /> Depth to water <br /> Mix RatiosFilter Pack type/size <br /> f e �1 cQ <br /> -Surge Block - (y/(D <br /> Installation Method <br /> Disc= <br /> wed Installed ssed with geology - � n) -���"-d' <br /> Type of method <br /> F.H 29 29 / <br />