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MONITORING WELL INSTALLATION REPORT <br /> Date:_ !a 12.; In 7 CONSTRUCTION <br /> Premise Address:... { yo Total Depth X20 t <br /> Screen Length (from) I�o _I z _ <br /> Well No.: Wt t x -1 K Filter Packl;'"{from)_ 66-l ZC> (to)-6 <br /> Inspector- _. � Bentonite (from) $Y'-lob' (to) LI- --=�?� <br /> Grout (from) -o- (to) A t <br /> Permit No. <br /> ��� 2 Drilling rig type Sania <br /> Y Auger O.D. _ <br /> LD. <br /> Drilling Company: -� Completion - Stove pipe/duistie box (cir-- <br /> �Qy.P01 <br /> Driller. t'r%%AeA <br /> casing <br /> � � <br /> Consultant � ®AA A.a21:�1 �' � height <br /> Geologist_ At_6�e. �+v�P _ <br /> O AEOVE-GACUND <br /> CONPLFrION C7�ZT(-aox <br /> SPECIAL PERMIT INFO. COMPLETICN <br /> G=rd Stzfac* <br /> Distance to sewer line Ora t <br /> Domestic well on site - (Y/ <br /> If yes, location and dist <br /> SAMPLING c <br /> 0 <br /> c <br /> Holding Temperature <br /> Method I - <br /> Screening Method 110, <br /> Tracking Shcet - (y/ n ) <br /> SPOILS tt• <br /> Storage Method_Cby_ <br /> Contamination Noted - (y/l MATERIALS/DEVELOPMENTr <br /> Storage Location m., ei Casing e_ L <br /> Blank Sae &-Vmw ft. Screen- see <br /> GROUTING Slot size-.d= - <br /> Bags cement <br /> Depth to water Buckets bentomre <br /> Mix RatiosBags sand/gravel <br /> Installation Metho 2 ° Fiber Pack type/size z i r <br /> Quantity Installed N I c ( Surge Block. - (y/ <br /> Discussed with georo ist: - (y <br /> EH 29 29 Type of method <br />