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I MONITORING WELL INSTALLATION REPORT <br /> Date;_ t.t•,IDS CONSTRUCTION <br /> Premise Address; ZZO is ti- r i_ Vis( Total.Depth. G V <br /> Screen Length (from) SsS-9 <br /> Well No.: (7S ' Filter Pack (from) la. -!5r> (to). 5w747 <br /> 13entonite (from) 61 -4r7- (to) <br /> Inspector. _ ln w r o�a Grout (from) <br /> Drilling rig.type' <br /> Permit No. 15 KI I Auger O.D. <br /> lo ' LD. <br /> Completion - Stove pipe/clidstie box (circle one) r <br /> DrillingCompanr, <br /> Driller:_ Trn . .r <br /> Consultant ✓��// <br /> Geologist �OeXr- gr4 Vn¢ <br /> b %J grout <br /> SPECIAL PERMIT INFO. �� seal <br /> Distance to sewer line <br /> Domesdc well,on si - (y•/n) <br /> If yes, location distance - <br /> gravel pack <br /> bS ft. <br /> SAMPLING - ----- - <br /> seal <br /> Holding Temperature a-.,. t-r A <br /> Method �nct <br /> Screening Method - <br /> Tracking Sheet - (y/ n ) SO <br /> ft: <br /> gravel pack <br /> SPOILS <br /> Storage Method d,^5Ift — O�/�MvninnDr,/ MATERIALS/DEVELOPMENT <br /> ContmInadon Noted - Mn) <br /> Storage Location Casing type_- Z"ftlr _ <br /> Y� * au, Blank fr. Screen fr. <br /> l Slot size l <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water ✓V K 6 � ' Bags sand/gravel . <br /> MIX Rados Filter Pack type/size -zf L sae. <br /> ipstallation Method( -M A coy V S Surge Block: - (y/ii <br /> Quantityinstalled.y ?vd e�of (Gew5 Discussed with geologist: - (y j <br /> Type of method <br /> EH 29 29. <br />