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MONITORING WELL INSTALLATION REPORT, <br /> I ! Y CONS ON <br /> Date*._ I <br /> � D ^ Total Depth to) �-SSSDC (to) 7 UPremise Address: Screen Length fr <br /> Filter Pack (from) ( <br /> — <br /> 3 ; (to)�IT— <br /> Well No.: P1 UVLO/ I 2 Bentonite (from) <br /> Grout (from)_,,g <br /> <to) <br /> Inspector. Drilling rig type r f—.- i`Imo` J <br /> Auger O.D.__ ___ <br /> Permit No. _ Completion - Stove pipe/ tie 6 x (circle one) <br /> Drilling Company: � � �`�� <br /> / casing <br /> Driller: 1", V� " �� Ing height <br /> Consultant-- <br /> Geologist �n " I d^ o� M N <br /> ABOVE-GRCUND qK4it5TY-80X <br /> CCtFLETCN CC APL=-MCN <br /> Ground Swiact <br /> SPECIAL PERMIT INFO. <br /> Aran <br /> Distance to sewer line 3 ft. <br /> Domestic well on site - (y/ n) ft. <br /> Ifyes, location and distance - tt <br /> - m <br /> t = e <br /> SAMPLINGsacicn <br /> Holding Temperature <br /> Method "= <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> Storage Method 5 s MATERIALS/DEVELOP <br /> MENT <br /> Contamination Noted - (y/ ) Casing type_ — <br /> Storage Locationy �^^ Blanc S ft Screen_ h <br /> Slot size <br /> GROU I1NG Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> P Filter Pack type/size <br /> Mix Ratios Surge Block: - (y/ n ) <br /> Installation Method Discussed with geologist: - (y/ n ) <br /> Quantity installed Type of method <br /> EH 29 29 <br />