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MONITORING WELL INSTALLATION REPORT <br /> l I t �D 5f CONS MICTION <br /> Date: <br /> f �_a g S f? Total Depth 1001 <br /> Premise Address: W�( I Il eww�^��9y Screen Length (from)------I-5 Cto) I(b <br /> �lu� Filter Pack Cfrom)_.-T— <br /> Well No.: n«[✓' Hawn w cJ t Bentonite <br /> J cc Grout <br /> Inspector. Drilling rig type <br /> $S S q Auger O.D. I.D. <br /> permit No. Completion-Stove pipe/chrisue boa (circle one) <br /> Drilling Compal W_ 6 ( <br /> cas:nq <br /> Driller. `7rn "• — —The_ght <br /> Consultant <br /> � 1�-V-tti� • r <br /> Geologist sN� � - 1�3CYE.u7CtlND 0-GvS;Y,aCX <br /> C,�bP_Tl1N C.^MP_=a ICN <br /> Gaxslld Stztaca , <br /> SPECIAL PERRVLrT INFO. � <br /> Distance to sewer line <br /> Domestic weIl o ' e - (Y/ n ) <br /> If yes, Iota ' and distance - —tL <br /> c <br /> Waned <br /> SAMPTUNG <br /> Holding Tempe-rature to i`r n - <br /> Method <br /> Screening Method e10 <br /> Tracking Sheet - ' / n ) <br /> .L r Ion tL <br /> SPOILS <br /> K► <br /> MATERIALS/DEVELOPMENT <br /> Storage Method 15b <br /> Contamination Noted - C y n ) Casing— <br /> ye C <br /> Scree <br /> fr- nStorage Location Blank 5fL <br /> Slot size 20 <br /> GROLTI ING Bags cement <br /> Buckets bentonite <br /> Depth to water N fG0 Bags sand/gravel <br /> Mia Ratios Filter Pack type/size ? <br /> s i m�� k_�-M Surge Blosed w - (y/ a) <br /> Installation Method ^ <br /> Quantity Instilled Discussed with geologist - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />