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V r; MONITORING WELL INSTALLATION REPORT <br /> J <br /> Date: p <br /> CONSTRUCTION <br /> Premise Address: I <br /> X4 CIA Total Depth SO <br /> Well Na.: Screen Length (from) <br /> Filter Pack Morn)__ !3 — l <br /> Inspector. Bentonite (from) —(to} 0 <br /> Grout {to) -`t3 <br /> (h om) <br /> Permit No. 3 �' Drilling rig type {to) � <br /> Auger O.D. <br /> Drilling Company: r r� ' ;Completion Stave i I.D. <br /> {� t P Fewlristie box (circle one) <br /> Driller: <br /> Consultant. _ T77 <br /> heigfit <br /> y <br /> Geologist ' .,� i • C : , s�..z , <br /> SPECIAL PERM]T INFO. ' f.CG-AiSTy aOX <br /> Disran <br /> ce to se ver-linel s <br /> } ` ' er <br /> Domestic well onsite - .y `� �• ' � ' ` - - i <br /> l;y loca n :- ] _ t _ rout <br /> es, tion and stance } .ti ;, A, "°. T �` ,Q ri- � <br /> �• ,• �:� ? _ .--ice••—�� • <br /> 11 - Ck c <br /> SA, ^ <br /> :• n <br /> Hold "" ,�•r a ,d r tlaroi a , r� <br /> Ing Temperature" <br /> Method <br /> Screening Method' 4 i p •�: _ VnvatF,,� <br /> Track Sheet _ ,y n.) ;• ' z w <br /> Sp <br /> OILS t <br /> Storage -Method <br /> Con tam in a tion,Nored.. <br /> Sr'orage Locatibn (Y f A� yDEVEE.OPMENT <br /> n c �� Casing type + jZ. U+t <br /> Blank <br /> CR` , ^1 j M Slot size . ft' Screen fr. <br /> L 1 f'' Bags Cerrlent <br /> Depth-to Water (' C_ Ls bcrtco <br /> Mix Ratio's T3ucke hire N -Z x a <br /> Ins[allatio r•. ..; x.�Bags sand/gravel inJ' l,0 <br /> nAfetho.d i .. .t ;`Filter Pat'k typejsize- <br /> Quantity Installed <br /> `3 SS <br /> (Y <br /> ( <br /> Surge Block: <br /> t' x - <br /> EI 129 29 f tDiscussed:with geologist: <br /> Type o r'icEll cd - {Y <br /> I <br />