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MONCCORING WELL INSTALLATION REPORT <br /> / CONS <br /> Date: 4� Total Depth <br /> from)_�(to)_--- <br /> Premise Address: Screen Length C (to)� <br /> Filter Pack <br /> 01C-F) y c(�� Bentonite (from) <br /> Well No: Grout <br /> Drilling rig type <br /> inspector. Auger O.D. <br /> /chrisde box (circle one) <br /> Completion . Stove pipe <br /> Permit No. <br /> Drilling Company: c as ing <br /> Driller: _ <br /> he-•9ht <br /> Consultant <br /> �� �� pp �v -�acur+o cr�tsrY.aox <br /> Geologist <br /> l�}sXx 5 Coy pLETfON GOt,U�tc'tIGN <br /> ��...Cxcurd Stztxa <br /> TINFO. Tc/GI�/'� 9ca.K Y7 �7` v <br /> SPECIAL PERMI kilt _ It. <br /> Distance to server line <br /> tt. <br /> Domestic well on site .- (Y/ n) t�9 <br /> 131 <br /> If yes, location and distance - .sly <br /> _ M <br /> O <br /> C <br /> O <br /> C <br /> itOC.a3 _ �F <br /> sot cn <br /> SWPUNG <br /> Tem re eratu <br /> Holding p _ <br /> Method = •. <br /> Screening Method w = It. <br /> Tracking Shcet (Y/ n) - 101t]L <br /> SPOILS MATERIALS EVEt'OPMENT <br /> Storage Method Casing type <br /> Contamination Noted • (Y n Blank ft Screen�� <br /> Storage Location Zo <br /> Slot <br /> Bags cement <br /> Buckets bentonite <br /> GRA Bags sand/gravcl <br /> Filter Pack type/size <br /> Depth to water Surge Block: • (Y <br /> Mut Rados Discussed With geologist: <br /> Sstalladon Method Type of rtediod <br /> Quantity Installed <br /> EH 29 29 ' ' <br />