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MONITORING WELL INSTALLATION REPORT <br />r <br />Date:_ <br />Premise Address: � _ nn P <br />^^ �n <br />Well No.,'"— S 4 <br />inspector. _ lain , .� C^ � <br />Permit No. 6Z cl O(' <br />Drilling Company: ldlia�a a /' <br />Consultant (10"nd t^y F(z. 1 <br />Geologist &f'ac-a' <br />SPECIAL PERMIT INFO. <br />Distance to sewer line <br />Domestic well on site - <br />If yes, location and • nce - <br />SAMPLING <br />Holding Temperature <br />Method A''„mn" " sLa. <br />Screening Method r i D <br />Tracking Sheet - 0/ n ) <br />SPOILS <br />Storage Method <br />Cont4minadon Noted - w coc�e�• <br />Storage Location flln S•1 (w <br />GROUTING <br />Depth to water N i <br />MIX Rados <br />=InsWladonMethod <br />QuantityInstalled <br />EH 29.29. <br />n <br />L <br />CONSTRUCTION <br />Total Depth 5e Z' <br />Screen Length (from)(co) <br />Filter Pack (from) <br />Bentonite (from) <br />Grout (from) (to) <br />Drilling rig type <br />Auger O.D. I.D. <br />Completion - Stove pipe/christie box (circle one) <br />grout <br />7zcLft. <br />seal <br />—V�ft. <br />MATERIALS/DEVELOPMENT <br />gravel pack <br />seal <br />gravel pack <br />Casing type I" <br />Blank ft. Sere en5iaow/e55-3 fr. <br />Slot size <br />Bags cement <br />Buckets bentonite <br />Bags sand/gravel <br />Filter Pack type/size <br />Surge Block: - ( y / n ) <br />Discussed with geologist: - (y/ n ) <br />Type of method <br />