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M 'kONITORING WELL INSTALLATION REPORT <br /> Date : — 0 — CONSTRUCTION <br /> ; � . <br /> Premise Address :_ o?A.S`b 1E .0'r5r) Total Depth <br /> /{ /(� o]� Screen Length (from) <br /> Well No. : (to) <br /> / F;7re pack (from) (to) 3� <br /> Inspector: '/. /� .J(j— Bentonite (from) <br /> O <br /> (to) <br /> Bentonite fir, <br /> Grout (from) (to)_L__ <br /> 53Z1� 7 / y7 � Drllingrigtype�1 <br /> Permit No. Auger O.D. <br /> f_— I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: ivl <br /> Driller: VV97 <br /> casing . <br /> ^ � height <br /> f7F <br /> CORSu]YaRY <br /> Geologist )"j <br /> A80VE-GROUND <br /> COMPLETION CHRISTYWX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground & rlace <br /> Distance to sewer line grout <br /> Domestic well on site - ( y / <br /> If yes, location and distance ft. <br /> SAMPLING slotted — c <br /> Holding Temperature section <br /> Method = graM Pack <br /> Screening Method <br /> Tracking Sheet - ( y / n ) _ <br /> SPOILS <br /> Storage Method M_ ATERIATS/DEVELOPMENT <br /> Contamination Noted - ( y / n <br /> Storage Location L) N 2 1 %712 �l wlZ � Casing type ?✓G <br /> / ` Blank P— ft. Screen fr. <br /> ��f j VYL J — V /�l Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite / <br /> Depth to water Bags sand/gravel <br /> Mix Ratios 1 506n, yv 3 PfL' Filter Pack typesize <br /> Installation Meio 7keA41 ,1Surge Block: - ( y / n: <br /> Quantity Installed 7y* l3rY� Discussed with geologist: - d/ n ) <br /> EH 29 29 153TYPe of method <br /> /N <br />