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MONITORING WELL INSTALLATION REPORT <br /> Date: / CONS=CITON <br /> Premise Address: Total Depth —70 <br /> Well No.:__ Screen Length (from)* (�,o (to) 76) _ <br /> Filter Pack (from) C'W (to) <br /> Bentonite (from) (to) _ <br /> Inspector: In n/t1.t Y Grout (from) - (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. 4z Y"SO <br /> Drilling Company:_ <br /> (� ` Completion- Stove pip gle x (circle one) <br /> _ !'7" <br /> Drillez• �Icvn �,2TP 14 <br /> casing <br /> n c T height <br /> -/] <br /> Consultant (� {yl <br /> Geologist 1J(` A^ Ak It�AA..1 <br /> ABOVE-GROUND <br /> bwLE CN CNRM_BCX <br /> SPECIAL PERMIT INFO. Grour)d Surto COMPLETION <br /> Distance to sewer line procrt <br /> Domestic well on site - (y <br /> If yes, location and distance <br /> ft. ft. <br /> • .Yi. <br /> SAMPLING ar,r�� (� {-u `7!� ''. = o <br /> • L?C�Or1 = <br /> Holding Temperature = <br /> Method S�!4" SDoon 5�n�p v� _ _ prayst pads <br /> Screening Method <br /> Tracking Sheet (y/n) _ <br /> SPOILS <br /> Storage Method �j 6►� MATERIALS/DEVELOPMENT <br /> Contamination Noted - /n) <br /> Storage Locationof) Casing type SGLr � <br /> BlankQ ft. Screen_jj <br /> Slot size oa-U <br /> GROUTING Bags cement <br /> Buckets tonite <br /> Depth to water 2 D Bags gravel <br /> Na Ratios i rN ohs �Y" Filter Pack type ize <br /> Installation Method v p ______ ._Surge_Block:_ '/n-) <br /> Quantity Installed Discussed with geologist: - (y/n ) <br /> EH 29 29 Type of method___ AUJO <br />