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MONITORjNG WELL INSTALLATION REPORT <br /> Premise Address: CON —TpUC770N <br /> hr Total Dcpth <br /> tiWelI No.: 1 _ _ Screen Length (from) <br /> Filter Pack —(to)— <br /> Inspector: {from} [ <br /> �._ Benronire (from)_ <br /> PetTnit No. Grout (from} p ^(C°) —� <br /> S Drilling rig type <br /> DAuger O_D. I.D. <br /> ulling Company; � � Completion - 5tovei c . <br /> P P /d ristie box (circle one) <br /> Drw�Ier. <br /> Consultant caszng <br /> Geologist � <br /> A-°C YE-G R CCND <br /> SYECI".L PERMMT INTO CCI,4­'LETr-N G-ASTY3oX <br /> c r, s�.r C`��cN <br /> Dis;a-nce to sewer lire <br /> Domestic well on si[e,�(y/ n ) <br /> 1 lccaon.a "distance _ <br /> 5 �?I2 N G <br /> a <br /> c <br /> PclCing Temperarizre iforai <br /> Screen r:g Method r <br /> Iracking Shcet <br /> ' (Y/ n ) <br /> C-ILS <br /> Stcrage Merl:nd <br /> Cc tan r anon Noted- 7 <br /> S[crz e /n ) MATERIALS FVEt.OPMEI�I`f` <br /> Lccar:on <br /> Casing type 2- " 2 <br /> CSG Blank .S fr <br /> — G Screen <br /> Slot size <br /> • t� Zp <br /> DePIJ� to water ` Bad Cement <br /> Buckets bentonite <br /> Bags sand gravel <br /> ns11�lad0n Method <br /> I1 :airy Installed Filter Pack type/size <br /> Surge Block: - (y/I1 } <br /> r;� 29 29 Discussed with geot, _ { Y/ <br /> Type of Method <br />