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ONITORING WELL INSTALLATION REPORT <br /> Date: 7��/fir � ® � Total Depth 7 <br /> tL�Gb <br /> Premise Address. �G s � P <br /> Screen Length (from)_-'V (to)S <br /> Well No.: Filter Pack (from) J (to)� <br /> I,� n n Bentonite (from (to <br /> Inspect or. Cd7 �--�-C�C Grout (from ��� (to) <br /> Drilling rig type �C <br /> Permit No. Auger O.D. /)l Y I.D. S 7, <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: A' DF <br /> Driller: Fm7 <br /> � casing <br /> height <br /> Consultants �g <br /> Geologists-9�F�"u`•L r11hJ^ A9gyEGR XJND <br /> COWLEMN 00%i EMCN <br /> �CQM?t_�TICN <br /> SPECIAL PERT INFO.S <br /> MI + <br /> prat <br /> Distance to sewer line t b <br /> Domestic well on site - (y/ n) T tt. <br /> If yes, location and distance - h. <br /> a <br /> SAMPLING slorai <br /> tocicn <br /> Holding Temperature <br /> Method = <br /> Screening Method <br /> Tracking Sheet - (y/ 11) ` '— <br /> �=tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) Casing type : `jf k) <br /> Storage Location Blank ro fc. Screen D — <br /> LR• <br /> Slot size—_0 020 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water S Bags sand/gravel <br /> z _C n^ /�— <br /> Mix Ratios Filter Pack type/size <br /> -installation Method Surge Block: /11 ) <br /> Quantity installed Discussed wi eologist: -0Y n) <br /> Type of method_ �// <br /> EH 29 29 <br />