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MONITORING WELL INSTALLATION REPORT <br /> 0 CONSTRUCTION <br /> Date: ,a /' �� �p <br /> �39 S,.O � jlvA��. Total Depth 36 i (to) 2U <br /> Premise Address: __'__ Screen Length (from) 30 , (to) 8" <br /> �`�� , rT Filter Pack (from).—�7-- �r e <br /> Well No.: Bentonite (from) /7 p— (CO)-1 S <br /> 1/ Grout (from) /S r /� �� (to) <br /> Inspector. r Drilling rig type <br /> Auger O.D. I D. 2s <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company <br /> casing <br /> �y e- r ez / height <br /> /l� r r <br /> Driller• J� N e <br /> Consultant <br /> Geologist A-�/`IE-GRCUND CHAtV N-3ox <br /> ccYPLRCN COMPL-°TICK <br /> Gccurd Su•tx" <br /> SPECIAL PERMIT INFO. groat <br /> Distance to sewer line i/ ft. <br /> Domestic well on site - (y�� /7' ft. <br /> Ifyes, location and distance - �p ft. <br /> •� A <br /> _ C <br /> O <br /> tIOC.p.•i .�% _ <br /> sAWLIN G iQCcn — <br /> 4f71Y�F <br /> b — <br /> liolding Temperature <br /> Method D <br /> • z — <br /> Screenino Method <br /> Tracking Sheet - (y n <br /> - �—tt• <br /> SPOILS <br /> •Re•rFu1Ai S/DEVEI.OPMEIVT <br /> Storage Method r <br /> /0 <br /> Contamination Noted - (y n Casing type <br /> Storage Location > ���'� Blank O ft. Screen--Z-Q---, <br /> Slot size � r� <br /> Bags cement 3, IN <br /> GROUTING Buckets bentonite <br /> Bags sand/gravel s / 0 <br /> �� Filter Pack type/size <br /> Depth to water S r f/�,�� <br /> Mix Rados Surge Block: - (y/ n <br /> Installation Me od ��A L61!11: Discussed with geologist: - ( n) <br /> Quantity Installed 3 - Type of method <br /> EH 29 29 <br />