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MONITORING WELL INSTALLATION-REPORT <br /> J <br /> Date:^ (0 3 o S <br /> Premise Address: b CONSTRUCTION <br /> ��- Total Depth <br /> Z l <br /> Well No'� +- <br /> ro <br /> Screen Len <br /> 8Th (Fm) {[o) <br /> Filter Pack (from) <br /> Inspector: 4 Bertronire (from} Cto) r <br /> Permit No. <br /> Grout <br /> Drilling rig type <br /> Auger O.D. <br /> Drilling CompanI.D. <br /> Completion - StoveP P i e <br /> /cliristiebos (circle one) <br /> Driller <br /> Consultant casing <br /> C) V � height <br /> F 7Geologist <br /> —WT <br /> A°CVE-GRC JND <br /> SPECIAL PERMIT INFO. CChPL.tTCN CF-A:S7y30X <br /> Gru:r4 Suiac-a -`71CN <br /> Distance to sewer line <br /> Domestic well on site - (y ) <br /> I'Yes, location and dis ce - prcvt <br /> 1-4 Z- - rt. <br /> SANG a <br /> 0 <br /> C <br /> Holding Temperature itorP,� <br /> Method taccn <br /> Screening Method gxvct <br /> Tracking Sheet - (Y/ n ) - F <br /> SP_ 1LSS <br /> !t. <br /> Storage Method �S' <br /> Contamination Noted <br /> Stora n) MATEWALSI OPMENT <br /> ge Location <br /> Casing type �V <br /> CR��'G Blame Screen fr <br /> Slot size <br /> Bags cernent <br /> Depth to Seater ,v Z Buckets bentonite <br /> Mix Ratios <br /> Insralla ' �-•- . Bags sand/gravel <br /> aon Method Filrer Pack typ <br /> Quantity Installed n, Surgc l3lock: - C Yl/ ,Zr c <br /> EH 29 29 °�'1 Discussed with geologist: - (y Imo} <br /> Type of method ,U <br />