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MONITORING WELL INSTALLATION REPORT <br /> Dater.$ 'o'L°l I b I-I � ( <br /> J CONSTRUCTION <br /> Premise Address: <br /> Total Depth I\CX <br /> Well No.:_ Screen Length (from)_ <br /> 1_ 0 H. (to) � <br /> Filter Pack (from) 1n�(to)�I� & <br /> Inspector. 11. �h Bentonite (frorn)_ q—�(to) 2� <br /> Permit No. Grout (from)— <br /> Drilling rig type —(to)— <br /> Auger C.D. I.D. <br /> Drilling Company1 A)moo, frA Completion - Stove <br /> �— pipe/dirisdebo—(circleone) <br /> Driller. y\ <br /> � A casing <br /> Consu]tant ,� l 7 height <br /> Geologist Ist?o <br /> A-00vE-GRCUND ^ <br /> SPECIAL PERMIT INFO. 00,F--`TCN GAS7y3OX <br /> CxouM Suirt N <br /> Distance to sewer line <br /> Domestic well on site <br /> l;yes, location and distance - <br /> f t. <br /> ft. ft. <br /> SAS <br /> _ c <br /> doral <br /> Holding Temperature <br /> Method aecicn = 3 <br /> _— <br /> Screening Method — grz S4Fa:tt <br /> Tracking Shcet - (y/ri <br /> SPOILS <br /> ft. <br /> Storage Method <br /> Contamination Noted - (y/n ) MATERIALS/DE�[_S/DEVELOPMENT <br /> Storage Location <br /> Casing type ev t <br /> CR— Slot siz—fr' Screen�_fr. <br /> Bags cement <br /> Depth to water <br /> Mix Ratios Buckets bentonite Insta]IatBags sand. <br /> /gravel Method travel <br /> Filter Pack type/size <br /> Quantity Installed Surge Block: - <br /> EH 29 29 <br /> Discussed with geologisr: . (y / n ) <br /> Type of method <br />