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M MONITORING WELL INSTALLATION REPORT <br /> X <br /> i <br /> Dater Zp CONSTRUCTION <br /> Premise Address : Total Depth <br /> Screen Length (from) 20 ` (to) `la ' <br /> Well No.: Mw _ Filter Pack (from) (to) W <br /> Bentonite (from) 15 (to) IV <br /> Inspector: `J /S (from) 76 (to) O <br /> Drilling rig type c anL - 7 5 <br /> Permit No. SRm>i > 38 Auger O.D. to LD. <br /> ii Completion - Stove pip /chriide box circle one) <br /> Drilling Company: (}) 1 W'E i I A 6Arj go d <br /> Driller: M &k A ,4, casing <br /> height - <br /> Consultant AAA j Ant' r> 6C n ( AVrAAM4AVA 1 <br /> Geologist <br /> R80VEmRCUND <br /> COWLET ION CNRO Y=Box <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Su lace <br /> Distance to sewer line "rout <br /> Domestic well on site - ( y / n ) <br /> If yes, location and distance - � 8 <br /> fr. <br /> _ m <br /> SAMPLING alottad = <br /> - - sacdon <br /> Holding Temperature <br /> Method <br /> Screening Method — <br /> Tracking Sheet - ( y / n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) <br /> Storage Location Casing type 501 £ Dy I e 9 n <br /> Blank Z ft. Screen 2n ft. <br /> Slot size Bbp <br /> GROUTING 5� 16) Bags cement <br /> (31aG-> �xeiEetrbentonite MFpiv ++� CNifa� 1 `/L <br /> Depth to water Bags sand/gravel I `I ( 5"v ISS <br /> it Mix Ratios Filter Pack type/size Ai ,? LAPr> LvD'TO /� <br /> Installation Method Surge Block: - ( y /Q) <br /> Quantity Installed Discussed with geologist: - ( y / n ) <br /> Type of method <br /> EH 29 29 <br /> I <br />