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MONITORING WELL INSTALLATION REPORT <br /> Date:_ t{I -Z,p I D <br /> CONSTRUCTION <br /> Premise Address: <br /> Total Depth 4,9 t <br /> Well No.: m C HAOA0-C ` Screen Length (from) <br /> J Filter Pack (from) (to) — <br /> Inspector, s <br /> 1�twn Bentonite (from)__ r—(to)'T <br /> Grout (from)_ —�_(to)—S — <br /> Permit No. (, Drilling rig type —C�o) —ALT <br /> Auger O,D, <br /> Drilling Company_ )D�(��r, ��, Completion - Stove pipe/duistie box (circle one) <br /> Driller: {io <br /> ,t casing <br /> Consultant_ f-y f _ �� height <br /> —wlw� <br /> Geologist ep. (L1�� ( .�,_,t <br /> AoAVE-GRCUND <br /> cOhPLETfCN G--R SM-Sox <br /> SPECIAL PERMIT INFO Ccx,tP ncN <br /> tour d Swire <br /> Distance to sewer line <br /> Domestic well on site - n) ora <br /> If yes, location an stance - <br /> SAMPLING +" c <br /> 0 <br /> tlaCad — � <br /> Holding Temperature i0hca <br /> Method <br /> Screening Method `•• <br /> Tracking Sheet - (y/ n ) r — • <br /> SPOILS <br /> Storage Method_ I-2!tnWtW111( MATERIALS/DEVE[OPMENT <br /> Cont4mination Noted - (y/n) <br /> Storage Location_ ax sr to Casinge <br /> type LL _ <br /> Blank Sq ft. Screen 2.15 ft. <br /> GROLMNG Slot size 02..¢1 <br /> Bags cement A.L <br /> Depth to water ny 30 `fid' /MeBuckets bentonite <br /> Miz Ratios Bags sand/gravel nv LO <br /> installation Method Filter Pack type/size_. 2 /Z- 'Go—w, f <br /> —R �4%Atnn��/ Surge Block: - (y/n <br /> QuantityInstalled Discussed vrith geol-9 t: - (y <br /> EH 29 29. Type of methody <br />