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MONITORING WELL INSTALLATION REPORT <br /> Date:_ n 2 CONSTRUCTION <br /> Premise Address: 9 G (p,14A 1— Total Depth <br /> Screen Length (from) (to) <br /> Well No.: S P- � ��,,((� Filter Pack (from) (to)�_ <br /> Inspector. _ jl�,,,���, Bentonite (from) (to) <br /> Grout (from) (to) <br /> Drilling rig type <br /> Permit No. O �{�, Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: casing <br /> he_ght <br /> Consultant�p�-,,,n� ,�r�iv n.�(�i( •4 ,y <br /> Geologist T <br /> ASCVF_GACtJND T <br /> COkPLZr CN CNAJSTY-30X <br /> SPECIAL PERMIT INFO. CCMPL_MN <br /> C3rwn0 Stztacs <br /> Distance to sever line gran <br /> Domestic well on si y/ n ) <br /> If yes, locati d distance - It. <br /> 121 ft. <br /> oZ-S' _ - <br /> SAMPLING — c <br /> _ o <br /> Holding = <br /> Temperature # 30 <br /> Method -" <br /> gnvw pack <br /> Screening v1—d 3 6 t = 5cti s�aGY_ <br /> Trackin cet - (y/ n ) _= <br /> s _.A .n. <br /> SPOILS <br /> Storage Method <br /> Contamination MATERIALS/DEVEI OpMENT <br /> Noted • ( /n ) <br /> Storage Location_ �,�,� �, C_, <br /> --� Casing type <br /> Blanks' - 2-97-56 ft. Screen_ L(ZL - -2 fr, <br /> GR�'G Slot size <br /> Bags cement <br /> Depth to water ti Zee Buckets bentonite <br /> Mix Ratios Bags sand/gravel <br /> Installation Method Filter Pack type/size-_ X30 <br /> Quantity Installed Surge Block: - (y/Col <br /> Discussed with geologist: - (y <br /> EH 29 29 Type of method QV <br />