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MONITORING WELL INSTALLA'T'ION REPORT <br /> t i't <br /> Date: 3 03 CONSTRUCTION <br /> +L Premise Address: 14a rdi na�S+ack+on Total Depth s t <br /> Screen Length (from) .S e (to) if <br /> Well No.: Filter Pack (from) 5 e (to) 23�e� � <br /> Behtonite� (from) 2 (to) <br /> Inspector: Y t Grout j (from) 2 -F (to) <br /> Drilling rig type AA S <br /> Permit No. 3 3 2 $ 8 Auger O.D. c I.D. i <br /> Completion - Stove pipe/cliristie box (circle one) <br /> Drilling Company: <br /> Cascade—. fir: l 1 rt The,, <br /> Driller: �6yl rq rn i}1 o casing <br /> he?ght <br /> Consultanty6 n-e <br /> 6&o ► � �ne-• i <br /> Geologist WillLaw L 1lSQYE�+'J�G�IJN>7 I <br /> ox <br /> d0WLr_-710 ! COMPLETION <br /> iWT <br /> COMPLETION <br /> SPECIAL PERMIT INFO. around S 'e' <br /> Distance to sewer line <br /> Domestic well on site - (y/ n <br /> if yes, location and distance - z3 ft 1 <br /> ,SAMPLING �lor.4.i <br /> iocicn <br /> Holding Temperature — 9M 91 Pack <br /> Method <br /> Screening Method <br /> Tracking Shcet - (y/ n ) — <br /> i <br /> pt <br /> SPOIIS � <br /> Storage Method 55 a)I o rL Q T r s PVIATEW�ALS/DEVELOPMENT <br /> Contamination Noted - Cy/ n) F <br /> Storage Location Casing type 2 <br /> Blank_:! zS ft• Screen Za ft. <br /> 41 Slot size D.b 2 0 i ngJi <br /> ' <br /> 4 <br /> Bags ceinent <br /> GROUTING } eEs�bcntonite 1119 <br /> Bags sand/gravel <br /> Depth to water L 3 i <br /> Mix Ratios 9q' u s Filter Pack type/size <br /> Sure Block: - <br /> Installation Metho Y Pis ussed with gcologist: - y/ n) <br /> Quantity installed Type drne.thod 1W try- <br /> EH 29 29 I <br />