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MONITORING WELL INSTALLATION REPORT <br /> Date: (0 1 l\ 0!5 CONSTRUCTION <br /> Premise Address: 1(,C-)%-$ Total Depth <br /> Screen Length (from) -(to) <br /> Well No.: m W' So NMN'`l Filter Pack (from) _(to) <br /> Bentonite (from) _(to) <br /> Inspector. tl. AA r to Grout (from) _(to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion-Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller. Q.a 1,, casing <br /> -T height <br /> Consultant �0 m jajgDc, 7 Ti <br /> U_ <br /> Geologist AW"VE-GaRCUND <br /> 0C P1_Er,,0N iRSSY-3CX <br /> =,ICN <br /> SPECIAL PERVL 1 INFO. fin'SLTfa= <br /> Distance to sewer line D <br /> Domestic well on site - (y/ n} 3'�L- <br /> If yes, location and distance - - T� <br /> 'r C <br /> O <br /> SAMPLING sla Lad <br /> Holding Temne*ature M <br /> � pack <br /> Method <br /> Screening Method g ;E _ <br /> Tracking Sheet - (y/ n) <br /> •'L _ ♦ fL <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - <br /> Storage Location Casing type Z "` PV .ice Yd <br /> Blank Y(1 ft. Screen 2-0 ft- <br /> Slot size � 07-C, <br /> GROUPING Bags cement <br /> Buckets bentonite <br /> Death to ware- ^' Z 'ZS Bags sand/gravel <br /> Mix Ratios Filter Pack typesize z 12 ✓.,yw 1. <br /> Installation Method Surge Block - (y/®) <br /> Quantity Installed Discussed with geologist: - Q/ ri) <br /> Type of method <br /> EH 29 29 <br />