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MONITORING WELL INSTALLATION REPORT <br /> Date:_ 3-� Jz��l CONSTRUCTION <br /> Premise Address: Total Depth 1 (o, <br /> Screen Length (from)— (cy c3' (to) Hol <br /> Well No.:- lnA c a7-l\ Filter Pack (from) (to) 1 t o <br /> from) <br /> Bento <br /> Inspector: (, — Groutnite (from) a� 1 (to) �(__ <br /> Drilling rig type <br /> Permit No._ (70 2 Auger O.D. " I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: C l nar c r <br /> Driller: casing <br /> Consultant r height <br /> ABOVE—GROUND <br /> T <br /> Geologist Ln cC COWLET)ON CN-GZTY-BOX <br /> CCMPLEnCN <br /> SPECIAL PERMIT INFO. Ground Surfsn <br /> Distance to sewer line V, afoul <br /> Domestic well on site - (y/ n) II- <br /> If yes, location and distance - ft- <br /> .._IS14R. <br /> = c <br /> SAMPLING = <br /> dorsi — � <br /> axicn — <br /> Holding Temperature _ R+vd F <br /> ack <br /> Method —_ <br /> Screening Method <br /> Tracking Slot - (y/ n ) , <br /> SPOILS <br /> Storage Method U�"' MATERIALS/DEVELOPMENT <br /> Contaminatio "oted - (y y n <br /> Storage Lp adon__C n���� C�-c kA Casing type 2-"ej C <br /> Blank Its b ft. Screen 0 ft. <br /> Slot size C9 z o <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 3 z t <br /> Mix Rados (wr Filter Pack arnn cQ <br /> ���_ type/size. 3� <br /> Installation Method nom. Surge Block: - (y/(n) <br /> Quantity Installed 2.AN,Brea Discussed with geologist•. - ( y <br /> EH 29 29 Type of method <br />