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MONITORING WELL INSTALLATION REPORT <br /> Date: I CONSTRUCTION <br /> Premise Address: 4 Total Depth Z 4s <br /> Well No.: Sk <br /> Screen Length (from) Z E,-(to) <br /> ��T <br /> - t � ��_ �_ Filter Pack (from)Benro <br /> Inspector. LNAA.r-c1� Grout (from) <br /> (from)_ LI ' < (to)__i--2-1�___ <br /> (from). � -(to)—i---r— <br /> Permit <br /> Drilling rig type <br /> Permit No. D`(� , Auger O.D. I.D. <br /> Drilling Company: (-x,�.���_ <br /> Completion - Stove pipe/christie box (circle one) <br /> Driller: N r,L <br /> ^,_ casing <br /> height <br /> Consultan <br /> Geologist <br /> AECVE-GaC(JND <br /> CCWl.Fr CN CW�1STl'-30X <br /> SPECIAL PERMIT INFO. COMPt—=ncN <br /> Ground S�.rtacs <br /> Distance to sever lineo+ <br /> Domestic well on rout <br /> site ". / n ) <br /> If yes, location an istance - 7-0 ft. <br /> SAMPLING — c <br /> 210rod c <br /> s�cn -� <br /> Holding Temperature/ ^ <br /> Metho _ �thod <br /> VIVWP ck <br /> Screenidnp� = <br /> Tracking Shcet - (y/ n ) <br /> SPOILS <br /> Storage Method_ r,(,, t MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y r <br /> Storage Location ov, ;fCasing type <br /> Blank z�� ft. Screen 2— <br /> GROOUTING Slot size L <br /> Bags cement_ <br /> Depth to water h/ 7- Buckets bentonite 1 <br /> Mix Ratios Bags sand/gravel <br /> G �" G Filter Pack type/size <br /> {= CJ <br /> Installation Method ,�,n, ( <br /> Quantity Installed ' Surge Block: - (yn a <br /> Discussed with geologist: - (y/ n� <br /> EH 29 29 TYP�f-raeth-od-- <br />