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MONITORING W.I.L.INSTAL?A'iiON R °ORT <br /> V LOti'S l i" f L� <br /> Date._— 9 <br /> .Sf <br /> ' ."°�t��.._ (.�! . � ����•�"-..- Total D e p:n <br /> Premise Address; Screen LenrLh (from) (to) <br /> l l £ Filter Pack (from (C0) <br /> well No.; ' -' <br /> Bentonite (iron::)_ (to) <br /> Inspector. _I'r y w.� — <br /> Dr-Ming rig (f om) (to) <br /> 3 typ- <br /> Auger O.D. I.D. <br /> permit No. Completion - Stove pipe/ci-L-Istie boy <br /> Drilling Company: <br /> he, ght <br /> Geologist ` G� � Cr-.nSTY-BIOX <br /> A <br /> SPECIAL PLEMI i INpO. l <br /> flrx� <br /> Distznce to sever lirer �- <br /> Do. :esdc vr.11 on sits - ( y <br /> If yes, laea6on and distance : #' <br /> M <br /> C <br /> 0 <br /> Sr�1�`r��plai�G 1J <br /> Holding Te;nperatl:.*e � �-- :�•: <br /> Method _ <br /> Screening Method <br /> Trac'tcing S:Cet - ( Y/ =- f. <br /> SPOILS <br /> MATERIALS/ - LOPMvIv'T <br /> Storage Method <br /> contamination Noted - (Y n ) Casing type <br /> Storage Location Blank fr Screen <br /> Slot size <br /> Bags cement <br /> GROUI NG EUr_kcts bentonite <br /> Bags sand/gravcl <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block; - (y/ n ) <br /> ipstallation Method Discussed with geologist: - (Y/ n ) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />