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MONITORING WELL INSTALLATION REPORT <br /> Date: �glo'- CONSTRUCTION <br /> Premise Address:_ � Total Depth <br /> Well No.: Lit Screen Len <br /> r 17 G-�t�, 0.c{w•1n12� 8th (from) (to)n �Filter Pack (from) - -- <br /> Inspector. /I l Bentbnite (from)_ �(to) 0- <br /> Grout (from) (to),;(_ <br /> �Cj� Drilling rig type No / p i S_l.e�-r1, <br /> Permit No. bb Auger O.D._ (0 " I.D. <br /> 6�� I I Completion - Stove pipe/ uistie o (circle one) <br /> Drilling Company: ri l t VLq� <br /> Consul 4�� casing <br /> `_(._r�� height <br /> Consultant cJ�1.�. n y�.. - <br /> Geologist �c all �S 1 (ryP�( \ <br /> A-EGVE-GaCUND <br /> COWLMON Ctff* Y3CX <br /> SPECIAL PERMIT INFO. CC+A+'LEMCN <br /> . C�ur4 Suiacl <br /> Distance to sewer line Qrat <br /> Domestic well on site - (y n ':2 <br /> If yes, location and distance - _L=_tt. <br /> II <br /> rili SAMPLINsodenHolding Temperature <br /> MethodScreening MethodTrackingShcet - (y/ n ) ft. I /• Il. <br /> SPOILS <br /> Storage Method ay-V MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ �(� <br /> Storage Location_ Casing type T VC- <br /> Blank 4-/7---- ft Screen s ft. <br /> Slot size <br /> GROUTING Bags cement <br /> r Buckets bentonite <br /> Depth to water �D Bags sand/gravel a S <br /> MIX Ratios Filcer Pack type/ i�yze M 1�A- <br /> Apstallation Method Surge Block: - y n ) <br /> Quantity installed Discussed with geologist: - (y/ n ) <br /> EH 29 29 Type of method <br />