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1 <br /> MONITORING WELL INSTAL.L.ATION REPORT <br /> r� I l 20 D <br /> CONSTRUCTION <br /> Date: <br /> OXY f�OL'au/�tr Total Depth <br /> Premise Address: 3 9 S CO" Screen Length (from) 3 V (to)_ 2 d <br /> Filter Pack (from) (to) <br /> Well No.:_ - 'S >/nom Bentonite (from) 7 � (to) <br /> Grout (from) /S! /l (to) G <br /> Inspector. /'G A Drilling rig type E IFII �S <br /> 0 U 3 'l 3 l G Auger O.D. S - <br /> Permit No. Completion - Stove pipe/chrtstie box (circle one) <br /> Ine', <br /> y <br /> Drilling Compan <br /> casing <br /> Driller: �P I L ' height <br /> � I Jeff ►-dor ke rna� _ <br /> Consultant <br /> Geologist r Y �e ABOVE-GACUNO C�ttSTY-3oX <br /> COh LC_- f0N COWPL._E71CN <br /> —Gmund SLrtac: <br /> SPECIAL PERMIT INFO. gram <br /> Distance to sewer line <br /> .r <br /> Domestic well on site - <br /> If yes, location and distance - gyp • _ <br /> C <br /> y�• J <br /> SAypLING - 11!A sac'icn <br /> Holding Temperature <br /> Method <br /> Screenino Method = <br /> Sheet - (y/ ) ar 3 tt. <br /> Tracking n T A_ tt. � --- <br /> SPOILS <br /> MATERI ALS�pEVEt.OPMENT <br /> Storage Method 1 S <br /> S, <br /> Casing type ��A <br /> Contamination Noted - (y/ <br /> 2Q C +e Screen <br /> Storage Location Blank �• r <br /> r <br /> Slot size �dD�c 9yf�� <br /> Bags cement �, <br /> GROt.t-I'ING Buckets bentonite <br /> Bags sand./gravel <br /> �' •3 �e��" .r-z Filter Pack type/size�'� Z �� <br /> �tetrKd <br /> Depth to water o <br /> Mix Rados r ' �S f -�' _94 Ib•bit eemQi,t Surge Block: - (Y <br /> Installation Ivtetizod3. <br /> Discussed with geologist: - (4/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />