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MONITORING WELL'INSTAILATION REPORT <br /> Date: 3 Zap "fd CONSTRUCT'ION <br /> i Premise Address: Total Depth 4 Z i <br /> i Screen Length (from) ' (to) ;2 ' <br /> Well No.: /►L .3 - Filter Pack (from) (to). 3Q <br /> Bentonite (from) 301 -(to) Z <br /> +ArN4 Groue (from) <br /> Inspector: , `1 1/'.�C.�_ � <br /> 1 ',Drilling rig type`" <br /> Permit No. Oma I EX <br /> Auger O D. I.D. • 2 ' <br /> f Completion - Stove pip �dbox (circle one) <br /> Drilling Company:_ Y ! �Pt <br /> Driller: EfD a e-r—he,ght <br /> C k rs s 0�nsa�-L n ,� <br /> .Consultant, Cp n d oY tQ r <br /> Geologist, CQ ABOVE-GRCUlND <br /> CCIYPLETfGN C STY-3oX <br /> GmAird Sulsea <br /> SPECIAL PERMIT INFO. <br /> Distance to :ewer line <br /> z -Frc*v sewr.Y <br /> Domestic well on site - (y/(n ) <br /> If yes, location and distance - R- <br /> v - o <br /> r <br /> C <br /> O <br /> - <br /> SAMPUNG so-cicn <br /> Holding Temperature rt .~ _ 9Mf°�P- <br /> ti <br /> .Method — <br /> Screening Method v ; <br /> Tracking Shcet )Uyyrli13. ,�-47 .a' <br /> Sl1 � 10AS� 1 iia-/✓� h. tt. <br /> Sa,l s 4 rs�p1 <br /> SPOILS <br /> Storage Method Y r�41P MATERIALS EVELOPMENT <br /> Contamination Noted - (Y/ Casing type <br /> Storage Location D S G Blank Z { Screen ' <br /> Slot size CAI <br /> GROIJTEI3G Bags cement • I '� -Tyra l� <br /> Buckets bentonite <br /> Bags sand/gra�el <br /> Depth to water 3S Filter Pack type/size <br /> Mix Ratios - �1 4��in5 _ <br /> i�stalIation Method 9H�d Surge I3iock: n ) <br /> Quantity lnstalicd r�14 Discussed with geologist: - n) <br /> jr ! Type of rnetltod r5 Y <br /> EK- 29• .� . <br />