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MONITORING WELL INSPALLAT ON REPORT <br /> Date:_ �.ti.�t 1 o S CONSTRUCTION <br /> Premise Address: q\4 t) Ci1,.� Total Depth yc <br /> Screen Length (from)_ (101 (to)Well No.: yV inl -'� — °ti Filter Pack (from) (to)� <br /> Bentonite (from) 6 s,Z (to)_ / g <br /> Inspector. Ovw cs Grout (from) j!' (to) A <br /> Drilling rig type sm,,ic <br /> Permit No. `� ff q 3 Auger O.D. I.D. <br /> Drilling Company: fL.nov.a�nA S©w,e Completion - Stove pipe/christie box (circle one) <br /> I <br /> Driller: o ®VIFcasing <br /> height <br /> Consultant �+�,. s i <br /> Geologist 12-a "- o VNam <br /> • A..C° 7VE-GPCUND <br /> COkPLEDON CKR* Y-BOX <br /> • <br /> SPECIAL PERMIT INFO. t3round gufxy COMPL-'ncN <br /> Distance to sewer line i Drax <br /> Domestic well on site - (y/rr) <br /> If yes, locatiot6 ce <br /> = c <br /> SAMPLING = <br /> ilarad <br /> socian <br /> Holding Temperature <br /> Method = <br /> Screening Method <br /> Trackin�,&!'icet - (y/ n ) <br /> tt. _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - y/- /n 11 <br /> Storage Location Casing type Z <br /> Blank to fL Screen ft• <br /> Slot size DLO <br /> GROUTING Bags cement <br /> Buckets bentonire <br /> Depth to water --,4Z>' Bags sand/gravel r3 <br /> Miz Ratios Filter Pack type/size z M <br /> dPstallation Method n T.�1 4 , Surge Block: - (y/ n ) <br /> Quantity installed � - AAIC _ U ^ Discussed with geologist: - (y/(j�)) <br /> Type of nethod <br /> EH 2929• . <br />