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MONITORING WELL INSTALLATION REPORT <br /> Date: 11 1 I D 5 CONSTRUCTION <br /> SI <br /> Premise Address: Fi 1 00 n} - w Cil screen <br /> om DDLength (from) (to) — <br /> Filter Pack Cfrom) G `{ (to) <br /> Well No.:`Nil 41/'�i Bentonite (from) (to) <br /> Inspector. IAAACGrout (from) (to) 6? <br /> Dn11mg rig type <br /> Permit No. Auger O-D. I.D. <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company. ln'X(.jn.. ( <br /> cas:nq <br /> Driller: �� n�/ ` �' he:ghc <br /> J- <br /> COI1s111rdI1L .�'f>_1Hri'ip <br /> Geologst Lt J� ICrnr/� H <br /> �lsl:.VE-w'�CUND ,;�4i7SY-3CX <br /> Crl p�=i',ON =4AP_=,ICN <br /> ���Gt�nd Strfan . <br /> SPECIAL PEFt.VL'i INFO. � <br /> v� <br /> Distance to sewer line b <br /> Domestic well on site - (Y/ 6 <br /> If yes, location and e - <br /> _ a <br /> 0 <br /> SAMPLING w <br /> Holding Tempeature Cn^ i ' I <br /> Method <br /> Screening Method <br /> Tracking Sheet - / n ) <br /> !L <br /> SPOILS <br /> Storage Method SS MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( ) Casing type 7 �.e✓C <br /> Storage Location fc <br /> Blank_ 6 Z fs. Screen ZO <br /> Slot size OZ-0 — <br /> Bags cement <br /> GROU7TNG Buckets benronire <br /> Bags sand/gravel <br /> Deprh to wale <br /> Filter Pack typesize At ? - -'4- <br /> Mia Ratios <br /> installation u ti Surge Block - C Y <br /> Quantity Ins alled Discussed with geologist - (Y/V <br /> Type of method <br /> EH 29 29 <br />