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MONITORING WELL.INSTAII.ATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: { S r i may(-& V1-q a Total Depth <br /> Screen Length (from) -10, (to) �p' 'Well No.: V^! U 'c) t I(' S( kc," 51+ Filter Pack (from) z (to)_ E,(�` <br /> Bentonite (from) (to) <br /> Inspector. kv-hr rn --- Grout (from) r=- (to) r- <br /> DrMing rig type_ - <br /> Permit No. Anger O.D. I I.D. <br /> Completion-Stove pipe/christie bozo (circle one) <br /> Dulling Company,� <br /> �,� casing <br /> DnMer: /` he; <br /> consultant �\tl ♦ ♦ ; <br /> i <br /> Geologist ILL\I-A 3�1 c_' �. <br /> A,3,.^VSwRCXJI`tD CHR:SY•e3CX <br /> trP'.:ibN CC'+AP1CN <br /> SPECIAL PERN11 T TNFO. Gr.Tir)d Sul'Ot t <br /> Distance to sewer line <br /> 1 <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - - IL <br /> — c <br /> SAIvLuLI?�IG wan = e <br /> Holding Temperature ! _ gm+si Zack <br /> Method h <br /> Screening Method P' ') — <br /> Tracking Sheet n) - <br /> _�.x. = htZ tL <br /> SPOILS <br /> Storage Method r J < �'�_ A MA7ER1ALS/DEVELOPMENTT <br /> Contamination Noted - y/ (¢) r , , <br /> Storage Location ' (A A.;(" Casing type <br /> Blank i(' ft- Screen• L_r? ft- <br /> Slot size � <br /> Gr�OUTING Bags cement_< <br /> Buckets bentonite I�4 r <br /> Depth to water -Y,,r`� /V- Q. Bags sand/grave. z <br /> Mia Ratios Fii te.T Pack typesize tA <br /> ;��n Z r Surge Block: - �/ n) <br /> Installation Method <br /> Quantity Installed ,�`1 �•11 .E Discussed with geology -�/n) <br /> Type of method k.{r., (� . <br /> EH 29 29 <br />