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MONITORING WELL INSTALLATION ATION REPORT <br /> Date: <br /> CONS�C-NON <br /> Premise Address: �(o�9 /�AL,/} _ <br /> Total Depth �s <br /> Well No.: $-7w9-7w la Screen Length (from) (to) Z6 <br /> Filter Pack (from) / <br /> Inspector: 1. YOPOW] Bentonite' —�(to) <br /> (from)_ _(to) t <br /> Grout (from) <br /> PermitNo. . 578/7 Drilling rig type I21vossi9 <br /> Auger O.D. I D <br /> Drilling Company: V d-W }q{1,41pjs Completion - Stove pip Christie bo <br /> (circle one) <br /> Drille�:_ V( � <br /> casing <br /> Consultant N4 Dq'( f f- iheight <br /> Geologist <br /> ABOVE-GSOUND <br /> SPECIAL PERMIT INFO, COMPLETION CH8ISTY4OX <br /> —_-------------- <br /> Ground Surface cOMPLEriON <br /> Distance to sewer line _ - - — -- ''��---�� <br /> Domestic well on site • (y/ ) grout / <br /> If yes, location and distance - <br /> ' ft. <br /> _ <br /> SAMPLING . ;. <br /> • &lotted = - c <br /> Holding Temperature &action = = 8 <br /> Method = <br /> Screening Method - _ fl YW Pack <br /> Tracking Sheet - (y/ ) y <br /> SPOILS r' — RSJ ft- Hkblb <br /> Storage Method <br /> Contamination Noted- ( /n) MATERLV S/DEVELOPMENT <br /> Storage Location <br /> Casing type 2^ PW -5e#,f 6uLE yo <br /> Blank /5 ft. Screen i <br /> GROUITNG Slot size o <br /> Bags cement <br /> Depth to waters Buckets bentonite 4ov T41 <br /> Mix Ratios Bags sand/grave, Ue B,Ba <br /> Installation Method_ Filter Pack type/ e <br /> Quantity Installed -----Siege Bloclt: - y_/n_) <br /> Discussed geologist: - (y/n <br /> EH 29 29 Type of ethod <br />