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MONITORING WELL INSTAI-LATiON REPORT <br /> 7 / CONSTRUCTION <br /> Date: I <br /> Total Depth <br /> Premise Address: Screen Length (from) <br /> Filter Pack (frosty) <br /> Well No,: !�'l Bentonite (from) (to)— <br /> �r\ivt o cwt Grout (from).- <br /> Inspector. <br /> from)Inspector: Drilling rig type <br /> Auger O.D. ipe/clirisLD. <br /> Permit No. Completion - Stove ptie box (circle one} <br /> Drilling Company: <br /> casfng <br /> Driller'*. 1 he-cht <br /> '� <br /> .1Fm <br /> Consultant <br /> Geologist ABOVE-GrRCUND C LST`l-2AX <br /> COWLETfON C)&tPL=nCN <br /> Gourd Suiacs <br /> SPECIAL PERMIT INFO. grant <br /> Distance to sewer line _ft. <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - ft. <br /> .�F M <br /> y: x <br /> O <br /> SS2WPL11�iG :o-cicn <br /> eFaoc <br /> Holding Tempera tut <br /> Method D <br /> Screening Method <br /> Tracking Sheet - /n n• <br /> Y <br /> SPOILS <br /> MATFWALS/DM[.DPMENT <br /> Storage Method <br /> Contamination Noted- (Y/ n) Casing type fr. <br /> Storage Location Blank fr— Screen <br /> Slot size <br /> Bags cement <br /> GROLMNG Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - (Y <br /> -ipstallationMethod Discussed with geologist: - (y/ n) <br /> Quantity Installed Type of nediod <br /> EH 29 29 <br />