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MONITORING WELL INSTALLATION REPORT <br /> Date:— Y✓1 aIq /oma/ <br /> CONSTRUCTION <br /> Premise Address: <br /> -�oOO �•/.Pt Total Depth <br /> SS Z � w¢p (1 <br /> Well No.:_MA (A) Screen Len <br /> Length- (from) z_ t_�(to)_Sr z <br /> Filter Pack (from) zz, (to)�� <br /> Inspector. Bentonite (from)_ zo, (to) <br /> Grout _(to.) 30 <br /> Permit No. 3 LI Y 5 Drilling rig type <br /> Auger O.D. — I.D. <br /> p <br /> Drilling Company (� o r t Comletion - Stove pipe/christie bo— <br /> --�_ (circle one) <br /> Driller. (� CQ , <br /> n <br /> casing <br /> Consultant � he-ight <br /> Geologist YLI��rA vYl /a l q <br /> A5CVE-GacuND <br /> SPECIAL PERMIT INFO. � 'L`7pN C7 A STy3p <br /> Cvoc:nd Suiacrr <br /> Distance to sewer lirlp- <br /> � <br /> Domestic well on site . " �� prat <br /> ]f yes, location and diGyn <br /> Stance P te` ' ^ 7 <br /> ft. <br /> ft. <br /> SA�yG 0 <br /> — c <br /> Holding Temperaturedorvd <br /> tocicn <br /> Method <br /> Screenir,omethod <br /> Tracking Shcet - (Y <br /> SPOILS 'S z R- — S6. ft. <br /> Storage Method Sf-etl. l ., yw.y 0 <br /> Contzmination Noted - (y/� MATEWALS/pE�E�NT <br /> Storage Location <br /> Casing type ptJC <br /> Blank �S Z- fc. Screen n <br /> GROUTING Blank <br /> size .0 2-0Z fr' <br /> Bags cement <br /> MiS <br /> Depth to water y H t Buckets bentonite <br /> x Ratios S Bags sand/gravcl—� <br /> Installation Method 3U Filter Pack type/size 2- 1 <br /> Z <br /> Quantity Installed Surge Block: - C y/ ) <br /> EH Discussed with geologist: - (Y/� <br /> F 29 29 Type of method <br /> i <br />