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MONITORING WELL INSTALLATION REPORT <br /> Date: 10� CONSTRUCTION <br /> Premise Address: ,'2,6 S . C W.rQA Total Depth <br /> Screen Length (from) S"3 _(to) �l <br /> Well No.: VN W-1 Gl Filter Pack (from) ti —(to) _ <br /> Bentonite (from) Y _(to) S' I <br /> Inspector. DAAA4 Grout (from)— ---(to) K <br /> Drilling rig type <br /> Permit No. S�{3� -4 Anger O.D. I.D. <br /> Completion-Stove pipe/christie box (circle one) <br /> Drilling Company, <br /> . - "-ClafL <br /> Driller. �[Y�`1 casing <br /> height <br /> Consultant S 1 wk 1M <br /> Geologist <br /> A3C1F-uRCUND CtSS Y-3CX <br /> CrbP'TAN C.^MP'=,ICN <br /> SPECIAL PERtiL T INFO. ���'c' <br /> A. <br /> Distance to sewer line <br /> 1 <br /> Domesric well on si - (y/ n) <br /> If yes, location distance - - IL <br /> ,L j <br /> i7' c <br /> _ c <br /> SAMPLING sloctad <br /> Holding Temperature ` __ <br /> gm-1;.adc <br /> Method - <br /> Screening Method <br /> Tracking Sheet - (y/ n) _= <br /> SPOILS <br /> Storage MethodCA-1 eta-Au st�• MATERIAL.S/DEVELOPNIENT <br /> Contamination Noted - y/ n ) to <br /> Storage Location Casing type Z <br /> Blank S 3 fL Screen ( S _fr- <br /> Slot size 07-0 <br /> GROUTING Bags cement -L l 2_ <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel I <br /> Mix Ratios - Filter Pack typesize — U <br /> Installation Method Surge Block - (y,(�) <br /> Quantity Installed Discussed with geologist: - (y C9 <br /> Type of method <br /> EE'i 29 29 <br />