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ONITORING WELL INSTALLATION REPIn 1 <br /> t. <br /> i <br /> i <br /> Date: Ly-a T CONSTRUCTION ~ <br /> // .t <br /> Premise Address: Get V705 Ce C&Al- ' <br /> Total Depth <br /> Screen Length (from) (to) <br /> Well No.: -tZ Filter Pack (from) <br /> (to - <br /> Bentonite (from) <br /> Inspector: ` — <br /> Pe Grout (from) to <br /> ��� � t`�•� Drilling rig typeL. <br /> Permit No. 7 Auger O.D. ,D, <br /> Completion-Stove pipe/ tie box (circle one) <br /> Drilling Company: <br /> Driller: i-M� 'j FaC casing <br /> b height <br /> `l Consultant_ <br /> Geologist <br /> sli ABOVE-GROUND <br /> COMPLETION ciiarsnr <br /> COMPtETlt <br /> SPECIAL PERMIT INFO. Ground Sulacs m <br /> Distance to sewer line so <br /> Domestic well on site - (YCD <br /> If yes, location and distance - fL- <br /> SAMPLING stoned ._ 3 <br /> Holding Te"tur %i <br /> Method : , praysi pack <br /> Screening;Method <br /> Tracking Sheet'' n) <br /> Storage-Method MMATERIAWDEVELOPMENT <br /> Contamination Note t y/rf –,44^t, <br /> _ <br /> Storage Locator .j&A Casingtype L. <br /> BTenk ft. Screen t ft. <br /> ' Slot size 02-0 <br /> GRO Bags.cement <br /> Bu&ets bentonite <br /> Depth to water Bags sand/gravel_ moo_ <br /> Filter P.ack`type/size <br /> Iristallat mediw <br /> ' .� SurgeBlocks= (y n <br /> Quiintity Installed <br /> Discussed with geologist: - (y <br /> Type of method <br /> Eli 29 29 <br />