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MONITORING ORING WELL INSTALLATION REPORT � <br /> Date: `l a2,z _yy CONSTRUCTION <br /> T -f��� / <br /> Premise Address: � Total Depth � 0 <br /> Screen Length (from) 7 'h- (to)--� <br /> Well No.: /f'!G(� G 2� Filter Pack (from)_�f (to) <br /> Bentonite (from) 2.s 1/2.- (to) <br /> Inspector.- Grout (from) e 3 -S (to)_ _ <br /> Drilling rig type /'46� S <br /> Permit No. Auger O.D. Sr " I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: �VL-� T <br /> casinghe_ght <br /> Consultant �" <br /> n <br /> Geologist TOP. 14±x-�vec.� �O� <br /> 0 ��„ S ABOVE-GROUND ��, <br /> 7S COWLErnN N <br /> SPECIAL PERMIT INFO. Ground S'l'c* ��"' <br /> Distance to server line 10 grout <br /> Domestic well on site - (y/a " .�ft. <br /> If yes, location and distance - n- <br /> fi. <br /> N <br /> C <br /> SAMPLING �loraiF <br /> socicn '- <br /> Holding Temperature .0cle% _ -' 9 -01 BSc <br /> Method <br /> Screening Method <br /> Tracking Sheet - (4V/ n ) <br /> SPOILS <br /> Storage Method >t� MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location C411 o cry Casing type <br /> Blank !f . � ft. Screen ft• <br /> Slot size , O/a <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size a 1 <br /> Installation Method Surge Block: - (V n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method 904 <br /> EH 29 29 �JG-c,.y� �¢� � <br />