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MONITORING WELL INSTALLATION REPORT <br /> Date:_ - � �A 0 CONSTRUCTION <br /> Premise Address: 1-0 Q, Total Depth CJ <br /> Screen Length (from)- SS- 90 (+) /r,_y� <br /> Well No,:_�S� Filter Pack (from) sz - 90 (-{-) T <br /> Inspect _ Bentonite (from) (aT-r6z (+f;. 15r-s} <br /> p �nnnrrn.` Grout (from) <br /> cSg 1 Drilling rig type <br /> Permit No, Auger O.D.' I.D. <br /> _ Completion - Stove pipe/chdstie box (cirde one) r <br /> Drilling Company: ( �rrac� . <br /> Driller: <br /> Consultant/ /�(�. <br /> Geologist OccceU lnOn- <br /> grout. <br /> _ S3•$ ft. <br /> SPECIAL PERMIT INFO. seal <br /> Distance to sewer lineft• - <br /> Domestic well on sit y/ n) <br /> If yes, location distance - <br /> gravel pack <br /> SAMPLING <br /> seal <br /> Hold ingTemperature- c(,Akr.F <br /> Method_ <br /> Screening Method . Y <br /> Tracking Sheet - (y/ n ) <br /> gravel pack <br /> SPOILS <br /> Storage Method S!S�ckej o MATERIALS/DEVELOPMENT <br /> Contamination Noted - W n) <br /> Storage Location_ oa&51 F,c ep.e'n 1.41 OA^0v(y315 Casing type__ <br /> ow cC en�pv�v Blank , G fr. Screen ft. . <br /> Vv Slot size , C I p <br /> GROUTING Bags cement <br /> Buckets bentonire <br /> Depth to water_ �� (c t Bags sand/gravel - <br /> Mfg Ratios Filter Pack type/size <br /> installation Method_ �,� u, l �l�� Mei -�5 Surge Block: - (y/n ) <br /> Quantity installed . Loo a Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 2929. . <br /> I <br />