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MONITORING WELL INSTALIATION REPORT <br /> Date: t, I L�t I 0`G CONSTRUCTION <br /> ti Cj Total Depth $S <br /> dress: —�--- Screen Length (from)— <br /> Premise Cs S <br /> Well No.: "' �" _Z Filter Pack Cfrom) (to) R'S <br /> Benronite (from) 1 2- (to) &{ <br /> Inspector. Il An rw • Grout (from) Cto) 6 <br /> Drilling rig type <br /> b SS 1 Z Auger O.D. I.D. <br /> Permit No. Completion-Stove pipe/chrisLie box (dtcle one) <br /> Dulling Company. Inlcnoc�t•1� •4,/ <br /> casing <br /> Duller ��� he-ghc <br /> r <br /> COS1SuIL3nL I:S=i V <br /> Geologist Li ABCVS GROUND Y-BOX <br /> Gond Stz:acs . <br /> SPECIAL PULWi INFO. <br /> / Qta1t <br /> Distanceto sewe line <br /> Domestic well on site y/ n) ` <br /> If yes, location dis ance - L <br /> c <br /> _ o <br /> SAI TiJNG Sac = B <br /> ascan - — <br /> Holding Tent-perature -L^^ l '^ _ gm"' <br /> Pack <br /> Me�hod L • l — - <br /> Sceening Method 1`117 <br /> Tracking Sheet - n ) 1 _ <br /> SPOILS <br /> Storage Method <br /> �5 C �nw MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y ncasing type Z tP VC — <br /> Storage Location �� 2 d m <br /> Blank �i � ft Sween <br /> Slot size O L <br /> Bags cemeU <br /> GROUTING m <br /> Buckets bentonite j <br /> Bags sand/gravel <br /> Depth to wale ni Z fi �( Filter Pack type/size '> <br /> Mia Ratios N Z 0 Y o Surge Block: - (Y/ a) <br /> Installation Method Discussed with geologist: - C Y/ u ) <br /> Quantiry Installed Type of method <br /> EH 29 29 <br /> 4 <br />