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MONITORING WELL INSTAILATit}N REPORT <br /> CONSTRUCBON <br /> Date: <br /> LA4Premise Address:_ 'L Taal Depth {to) <br /> j Screen Length (from)^ (te) <br /> h�� 1 r L Filter Pack (from) <br /> Well No.. -�._s._. Bentonite from) (t°) <br /> I Il.t r.� Grout (from) (to) <br /> Inspector Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion -Stove pipertie box (circleone) <br /> Drilling Company; <br /> Dosing <br /> IJriller:' he-,ght <br /> +nth <br /> I 7M �lv <br /> Consultant <br /> Geoto ist ;oVE.GFICiJ DOOhVLETCN <br /> c src-ac�x <br /> C�rc�urd Suiscs <br /> SpgCI ,PEftNEIT INFO. f(CL <br /> Distance to sel-ver <br /> Domestic well on site- y l n {. <br /> If yes, location and distance- � * <br /> SAMPLING sstc�crs -=` <br /> Molding Temperature -� <br /> Method <br /> Screen.na Method <br /> Tracking Sheet . y n) = -- <br /> SROI <br /> MA RIALS PMENT- <br /> Storage Method <br /> Contamination Noted- y!n Casing type <br /> Storage Location Blank __fr- Screen- <br /> slot size <br /> Bags cement <br /> GRGtmNG Buckets bentonite <br /> Bags sandlgTavcl <br /> Depth to water Filter Pack typefsize <br /> Mix Ratios Surge Block. - C Y 1 n <br /> installation Method Discussed vAth geologist:• (y l`n) <br /> Quantity Installed - Type of rnctllod <br /> EH 29 29- <br />