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MONITORING WELL INSTALLATION REPORT <br /> Date:_ l o L-I I'- PL� D Sr CONSTRUCTION <br /> yrH <br /> *'Premise Address: d , rn o Total Depth I <br /> Well No.: ivt Al— -- 1-4- Screen Length (Ecom)_ 1 I L (to) <br /> Filter Pack (from)_ _(to) <br /> Inspector. _ hMAACC % . Bentonite (from)— (to) 1 <br /> Grout (from)_ .O (to) <br /> u I Drilling rig type — —( �-- <br /> Permit No._ 1 Auger O.D. I.D. <br /> Completion - Stove pipe/dtristie box (cirde one) <br /> Drilling Company:._ fL:�Sav,r�� <br /> Driller:_ Jv+til �� casLng <br /> Consultant /'�, .. ('�, ,�. . - heLght <br /> Geologist_ ►2�a, <br /> ABOVE-GaCUND ` <br /> COMPLET)ON CKRZ iY-aox <br /> SPECIAL PERMIT INFO C I+'LnTCN <br /> �•--.-----.�4' vont Sts(act <br /> Distance to sewer line ora <br /> Domestic well on site - /n) <br /> If yes, location and d' ante - /fig IL <br /> r Z' ft <br /> - O <br /> SAMPLING = o <br /> slarai — c <br /> Hold ingTemperature r ,rte <br /> Method • <br /> Screening Method. �( D = <br /> Tracking Sheet - Fwh/ n) <br /> SPOILS <br /> StorageMethod MATERIALS/DEVELOPMENT <br /> Cont@mination Noted - /n) <br /> Storage Locadon_ og,a,75% Casinge_ <br /> �P y ! vc <br /> Blank I17- fr. Screen <br /> Slot size • 020 <br /> GROUTING Bags cement aW 3-2 <br /> Buckets bentonite <br /> Depth to water /`"10 Bags sand/gravel 2- <br /> MIX Rados I .✓ ,co, fjf2o <br /> �Ins[alladan Metho —17--" Filter Pack type/size z. iz � <br /> Surge Block: - (y/ 11 ) <br /> Quantity installed ^-fMv0 Discussed with geologist: - (y/n ) <br /> Type of method <br /> EH 29 29. . <br /> 41 1� / <br />