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MONITORING WELL INSTALLATION REPORT <br /> Date: -+ l o CONSTRUCTION <br /> Premise Address: l (o b'4 (2.1 5 4y-tA Total Depth 5� <br /> Screen Length (from) 39 -(to) -;'11 <br /> Well No.: A4 (rll' �� d hn LA I- Filter Pack (from) 3'l- _(to) <br /> Bentonite (from) 3S _(to)3 <br /> Inspector. D ttiPr1r o.,., Grout (from) _(to) 55- <br /> Drilling ng type <br /> Permit No. Auger O.D. I.D.— <br /> Completion-Stave pipe/christie box (circle one) <br /> Dulling Company. CA'r'.c b <br /> Driller. f�r,.ti�� ►, casing <br /> height <br /> 7 <br /> Consultant <br /> nn J <br /> Geologist ',rpvv,,/'f .A A&S o` AVS-GROUND <br /> =Npf-E 30N t t�'1'-e3CX <br /> SPECIAL PErLN—i INFO. �� c <br /> ' <br /> procX <br /> Distance to sewer line <br /> Domestic well on sit y/ n) 3 ti <br /> If yes, locatio distance - <br /> — a <br /> SANE UNG sbtwd = c <br /> Holding Temperature 9mv-Pack <br /> Method <br /> Screening Method _ <br /> Tracking Sheet - (y/ n) <br /> ..� ♦ <br /> SPOILS <br /> Storage Method - MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y Y n ) „ <br /> Storage Location m,. Sr i Casing type Z 1�V c' <br /> Blank______3 O ft. Scree= 2 o ft <br /> Slot size <br /> GROUTING Bags cemenr <br /> Buckets benronite <br /> Deuth to water N LI 5 Bags sand/gravel <br /> Mia Ratios Filter Pack Me/size t z <br /> Installation Method �^^ s Surge Block: - (y/0) <br /> Quantity Installed v Discussed with geologist - (y/(�n� <br /> Type of method <br /> EH 29 29 <br />