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MVNITORING WELL INSTALLATION REPORT'' <br /> Date: CLO�I�aw� <br /> Premise Address: LI Total Depth - <br /> Screen Length (from) 'AQ _605-21— <br /> Well <br /> (to) ZG1Well No.: K 3 Filter Pack (from) q (to) 2-� <br /> Bentonite (from) 2'} (to) Z <br /> Inspector: �av��' Grout (from) 24•-5 (to)_o <br /> p I Drilling rig type <br /> O <br /> Permit No. l3 U0 Auger O.D. I()'I=" I.D. <br /> Completion- Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller: Tcasing <br /> T height <br /> IV <br /> Consultant MAJU <br /> _QVT <br /> Geologist <br /> 4fdhal V//, <br /> ABOVE-GRCUND CHMM-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sumacs <br /> Distance to sewer line proof <br /> Domestic well on site - (y"no _;,ft. <br /> If yes, location and distance - ft. <br /> �.._.ft. <br /> a¢ p <br /> SAMPLING dot:sd <br /> R�,Qyp w' o <br /> /VD -� 1 ._ <br /> ;.. � <br /> secicn <br /> Holding Temperature .= <br /> Method __ gn Pack <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> -----ft <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n) <br /> Storage Location Casing type PVC <br /> Blank ft. Screen 2V ft. <br /> Slot size .0 <br /> GROUTING Bags cement <br /> r Buckets <br /> be <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 3 <br /> Installation Method Surge Block: - (V n ) <br /> Quantity Installed Discussed with geologist: - (j/ n ) <br /> Type of method <br /> EH 29 29 <br />