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MONITORING WEj L INS-rAU.ATION REPORT <br /> Date: y Zb(6� <br /> Premise Address: , ` CONSMuCTION <br /> Total Depth �{d� <br /> Well No.: _ Screen Len <br /> gth (from) <br /> Filter Pack (from)_ <br /> Inspector- Bentonite (from) -----(to) <br /> CA <br /> I (to) _ <br /> Grout (from) <br /> Permit No.�� �.5 Drilling rig type -� <br /> O D, <br /> Drilling Company; Augcr I.D.Completion - StoveP P i e <br /> /cliristie box (circle one) <br /> Driller- <br /> Consultant —,_ casing <br /> q height <br /> v f <br /> Geologist <br /> �l-°CYE-G,�CtJND � <br /> SPECIAL PERMIT INFOrCN <br /> . C0k9L C�AStY3oX <br /> Cx .:nd St.zi3c-t �`TCN <br /> Distance to :ewer line cc ` - <br /> Domestic well on site - <br /> If yes, location <br /> an istarice - I <br /> SAU_NG _ <br /> r <br /> Holding Temperature - ilorg-d <br /> Method i4<7cn $ <br /> Screening Me — <br /> Tracking S et - (y/ n ) crzvat <br /> SPOILS <br /> d ft, <br /> Storage Method <br /> Cozrf-m ation Noted <br /> Stora ge Location (Y/n) MAS,DEVELOPMENT <br /> Casing type It 7 <br /> GR_ O�� G Blank -y•L fr, Screen <br /> SIot size <br /> Depth to water Bags Cement <br /> Mix Ratios Buckets bentonite <br /> Installation Meth d - Begs sand/gravel .v <br /> Quantity installed . Filter Pack type/size <br /> Surge Block: - <br /> (Y/n <br /> EH 29 29 — Discussed with geologist: - (yl <br /> Type of Mediod v" <br />