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i 0 <br /> MONITORING WELL INSTALLATION REPORT <br /> CON_STR�N <br /> Date: <br /> Total Depth 0 <br /> Premise Address: "f S L 4 rC! 1_ r (to) a D �- <br /> Screen Length (from) (to)0 �� <br /> Al � _/ � Filler Pack (from) � <br /> Well No.: Bentonite (from) 3. E'(to) S <br /> V . i,' GIout (from) (to) S r <br /> Inspector. I GK 1 Drilling rig type 3 <br /> J \„nj•.oa I.D. .2 n <br /> D0 3L7 2 � .D. <br /> Permit No. Completion - Stove pipe/cltristie box (circle one) <br /> Drilling company: <br /> y�e2l^s �r�II;»a dr ft)Mf 60 . <br /> casing <br /> Driller. 1 i n'I Te '?Y Fri]—;FheLg t <br /> sista> ze <br /> 3)ri Ile, QS -F- <br /> Consultant to es 9z#_'z <br /> Jq e I Lf 2 m) n CtG1t5TY-BOX <br /> Geologist�t �I ,�,BgvE-GRcuNO <br /> AssiS+ant - �!/inLwl brow* COMPLETION <br /> J Ground SLsfxt <br /> SPECIAL PERMIT INFO. oD arart <br /> Distance to sewer line 0 ' �"�' 3. (t. <br /> Domestic well on site - (y/ n 5- ft. <br /> If yes, location and distance - ft _ <br /> a <br /> alorad � c <br /> SAMPLING <br /> sac'icn <br /> d �� � (7aY9I paGIC <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - / = tt. <br /> ' as e� tt. — <br /> SPOILS <br /> Orvm3 MATER!Atc/DEVEI.OPMENT <br /> Storage Method J- v G1 <br /> Contamination Noted - (y Casing type— <br /> Storage <br /> Storage Location n� +P — Blank__�__fr_ Screen 15 <br /> Slot size , <br /> Bags cement pr a <br /> GROUTING Buckets bentonite <br /> Ba sand/gravel <br /> Depth to water S� e ' e b q eeyneFilter Pack type/size' <br /> Mix Ratios Mia Surge Block. . (y/ n . <br /> Installation Metho u b o r} ICbxt �' Discussed with geologist•. - � n) <br /> Quantity Installed i 2S t/V Type of method <br /> C2+�20�rt/ <br /> EH 29 29 <br />