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MONITORING WELL INSTALLATION REPORT <br /> Date: O D CONSTRUCTION <br /> Premise Address: Z3b6 C^rAM -f f 14 Total Depth <br /> Well No.: 1M Screen Length (from)_ (to) <br /> Filter Pack (from) (to) If <br /> Inspector-. Bentonite (From) (to) r� <br /> Grout (from) (to)� <br /> Permit No. 2 Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/cliristie box (circle one) <br /> Driller. <br /> casing <br /> Const:ltant height <br /> Geologist T <br /> ABGVE-GRCUND <br /> Cal'FLETION CHRZTY-3oX <br /> SPECTAL PERMIT INFO. COMPt.._EMN <br /> Cxac;nd Su1ac� <br /> Distance to sewer line <br /> Domestic well on site - ( ) GraR <br /> If yes, location and ance - {t. <br /> H. <br /> a <br /> 0 <br /> S�G c <br /> slorwi :. c <br /> Holding Temperature (� tac�cn _ .$ <br /> Method <br /> Screening Method - �YNt <br /> Tracking Sheetn <br /> Y/ ) <br /> LP-0 <br /> P` o� a- <br /> Storage Method 5" p(/\�%A K, <br /> Contamination Note - /� MATERIALS/DEVELOPMENT <br /> Storage Location I , <br /> YS� E' Casing type <br /> Blank fr. Screen <br /> Slot size , oZ 0 �o ' <br /> GRA fr' <br /> Bags cement i <br /> Depth to water ti (O Buckets bentonite <br /> Mix Ratios I Bags sand/gravel <br /> Installation Method Filter Pack type/size <br /> Quantity InstalIcd <br /> N z =305' YSurge Block: - (y <br /> Discussed with geo/0 t: - (y/on 29 29 Type of method <br />