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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSMUCnQN' <br /> Premise Address; 00 Total Depth <br /> 111 � ., Screen Lem (from) <br /> t <br /> Filter pack (from) � ft <br /> too, Ao Bentonite <br /> Inspector: � 15 Grout (from) (to)- <br /> Drilling <br /> to) _.grill` g rig type <br /> Permit No. 50 1 00 auger O.D. I.l . <br /> Drilling Cornpany.--C4���. CompletiCompletion- Stove piechrisde b (circleone) <br /> I ri ler. <br /> casing <br /> height <br /> Consultant <br /> eologist <br /> SPECIAL PERNT INFO. Ground Surf <br /> Distance to serer line grout <br /> Domestic well on site µ yeta <br /> If yes, location and dist ' e <br /> gAMPLINGsI <br /> Holding` ernpera e <br /> qmvsi Pack <br /> Method <br /> Screening Method <br /> " raking Street n <br /> spom <br /> Storage Method— '5 <br /> pI ICI' <br /> Contamination Noted � f � <br /> Storage Location Casing e <br /> Blank ft Screen ft. <br /> Slat size Q -& <br /> 2GROUTING Bags ce ent <br /> Buckets tonit <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter paw type/size . . . <br /> installation Method Surge Black; - /rr <br /> Quantity In talled Discussed with geologist: - <br /> y e of method <br /> EH 29 2 <br />