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MONITORING WELL INSTALLATION REPORT <br /> Date: �D—Zy— "�[JJ/� CONSTRUCTION <br /> Premise Address: �ry o F-96410,q� �yl, ' Total Depth <br /> Screen Length (from) (to) 00 <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite" (from)�(to) �S <br /> Inspector: y /Wo d Grout <br /> Drilling rig type <br /> Permit No. 3id*0078763 Auger O.D. �'� .f-- I.D. <br /> A Completion- Stove pipe/christle box (circle one) <br /> Drilling Company: <br /> Driller:_ casing <br /> Consultant � /tas�, — �� height <br /> Ch= <br /> —VW T <br /> Geologist d)i4-W&L, ._ <br /> ABOVE-GROUND CHRZ-T1'-BOX <br /> COWLETION COMPLETION <br /> SPECIAL PERMIT INFO. G=nd Sulx <br /> Distance to sewer line ®rout <br /> Domestic well on site - (y/n) ft <br /> If yes, location and distance - <br /> — r <br /> SAMPLING = <br /> elottad — <br /> Holding Temperature _aA — M <br /> Method <br /> sr <br /> Screening M od <br /> Tracking eet - (y/n) <br /> ft. <br /> SPOILS <br /> Storage Method_ , AU <br /> MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location71UL� 6A3 > — 6"Ll Casingtype Z �Gr{, �0 ?l)c- <br /> Blank ft. Screen 'Z10 ft. <br /> UTING V �� I Slot size OZ-0GRO <br /> RS 0l � `..��"'i' I Bags cement <br /> _ Buckets bentonite <br /> Depth to water Bags sand/gravel L c7 <br /> Mix Ratios Filter Pack type/size 3 <br /> Installation Method_�// 7✓// <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method— <br /> EH 29 29 <br />