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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: . W Total Depth <br /> I r Screen Length (From) CEO) <br /> Well No., <br /> -l`i Filter Pack (From) CEO) <br /> 11 / Bentonite (from) (CO) <br /> ; Grout,Inspector {from Cha) <br /> Drilting rig e <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/chrisde box (circle on-2) <br /> Drilling Compe-ny:_ — <br /> ' GzS�rIC� <br /> Driller• _ ��� he-;ghc• � <br /> Consultant <br /> Geologist A.RAYE-GZCctND <br /> C-X=rd Sulact <br /> SPECIAL PirRMT INFO. flrart <br /> Distance to sewer line tt. <br /> Domestic wall on site = (Y <br /> lE yes, location and distance - <br /> O <br /> O <br /> SSA G D i4cicn � �t <br /> Holding Teweratu�re <br /> Method [? <br /> screeninz Method : <br /> Tracking Shcet <br /> 17�> r66 <br /> SPOILS ♦ - <br /> . _ MA'lERIALS EVE[.OPMENI' <br /> Storage Method A <br /> Contamination Not d - ( / n) Casing type f <br /> fr. Screen <br /> Storage Location Blank <br /> Slot size <br /> Bags cement <br /> GR.O_MN Buckets bentonite <br /> Bags 5and/gravcl <br /> Depth to water Filter Pack type/size <br /> Mik Ratios Surge Block: - (Y/n <br /> installation Method Discussed vAth geologist: - C Y/ n) <br /> Quantity Installed Type of rzcttivd <br /> EH 29 29. <br />