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MONITORING WELL INSTALLATION REPORT <br /> Date: ;3 3/ 0 CONSTRUCTION <br /> �3L� /� P� .�fi Total Depth 30 -� <br /> Premise Address: — Screen Length (from) 30 (to)_ 20 <br /> `�` Filter Pack (from) 30 ` (to)_ /fi ' <br /> Well No.: " <br /> Bentonite {from) ! ,U � —Eto) /L 3 <br /> Grout (from) 14 , 3", (to)_77 77'0«—_ <br /> «-- <br /> Inspector. — Drilling rig type Cry/F 7S <br /> 0 0 3 7 3 l� Auger O.D. .p I.D. 4 .2 S <br /> Permit No. Completion - Stove pipe/chrisde box (circle one) <br /> Drilling Company: 65 � <br /> �^ casing <br /> Driller: Erni e (� • height <br /> h0-To.0. J-e4- �rke � <br /> Consultant- <br /> Geologist — 2SterH � SeABOVE-GACUND C iszry_aox <br /> CONVLEtbN 124U -CEMN <br /> t <br /> � <br /> Gond Suaca <br /> SPECIAL PERMIT INFO. Gfout <br /> Distance to sewer line J3 �- <br /> Domestic well on site - (y p ft. <br /> If yes, location and distance - -2 p _ 76 <br /> � Q <br /> s1cr.A3 .•�, _ c <br /> SAMPLING sccicn _ <br /> PSC <br /> Holding Temperature <br /> Method ('tea <br /> Screening Method <br /> Tracking Sheet - (y n j =' 3 0 <br /> �". I.- n. <br /> Spoils <br /> MATERI ALSIDEVEI.OPMENT <br /> Storage Method +' <br /> Contamination Noted - (y Casing type SBfil <br /> Storage LocatiofL Screen 1 O fL <br /> Slot size 0 n <br /> Bags cement _ 6 D1e, u <br /> GROLPRNG Buckets bentonite <br /> a 3 r Bags sand/gravel D <br /> Depth to water �y �rc�yc� Filter Pack type/size 5 9 z - / <br /> Mix Ratios r�. Surge Block: - (Y <br /> Installation Method s - Discussed with geologist: - r►) <br /> Quantity Installed Tyre of method <br /> o <br /> EH 29 29 <br />