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MONITORING WELL INSTALLATION REPORT <br /> Date: O CONSTRUCTION <br /> Premise Address: 1 <br /> Tota! Depth <br /> s n IA)-S � l�W Screen Length (from) (to) 6 t <br /> Well No.: IV I Filter Pack (from) t{fS (to)--to — <br /> Benronite (from) <br /> Inspector. f Lt.CC Grout (from) $ (to) _ <br /> Permit No, <br /> 66F7 Drilling rig type <br /> oZEi Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: �� <br /> Driller: \ ) rnJ f casing <br /> t• <br /> height <br /> Consultant C-c)Y2 t <br /> e <br /> —q <br /> Geologist Ian r%cLS <br /> ABCVEGACUND <br /> COMPLETION C+%RZ Y-BCX <br /> CCMPLE71CN <br /> SPECIAL PERMIT INFO. C3rwtsi S�ztxs <br /> Distance to sewer line grout <br /> Domestic well on site - <br /> If yes, location an stance - ft. <br /> ft. <br /> •fid rt. <br /> = o <br /> SAMPLING — a <br /> tlotad <br /> sacicn - — <br /> Holding Temperature = <br /> Method G-Od� <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) <br /> tt. _ ft. <br /> SPOILS <br /> Storage Method �t n In ��, r MATERIALS/DEVELOPMENT <br /> Contamination Noted - y/0 <br /> Storage Location._ St'6t . (.oma A/ta " rh4Ao (�y S Casing type 2 <br /> B1anlc lj ft. Screen Z O ft. <br /> GROUTING Slot size •O-Lo <br /> Bags cement ^ 1 2- <br /> Buckets bentonite I L <br /> Depth to water /" Bags sand/gravel n ' <br /> Mix Ratios s� � Filter Pack type/size 3 nrw e <br /> Installation Metho � µ„tv" Surge Block: - (y An <br /> Quantity installed_ �_ 13y ti Discussed with geologist. - ( y dj <br /> Type of method <br /> EH 29 29 <br />