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MONTTORING-WELL LNSTALLATION REPORT <br /> Date:_ d L{ E Q 5— CONSTRUCTION <br /> Premise Address:_ Dl�/yy,cn.c �wa��o Total Depth qO <br /> Screen Length (from) 3 0 (ro) 6 <br /> Well No.: Filter Pack (from) Ll�?- <br /> Bentonite (from) 91ro <br /> _ <br /> Inspector, _ 4 �a _ Grout . (from) (t)� <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller:_-- cas{ng <br /> - -- <br /> height <br /> Consultant, C� C?S V <br /> Geologist oe U <br /> ABO E-GRCUNR C}- :5TY-2OX <br /> OClMir'LETfOhl C<>t • :MCN <br /> SPECIAL PERMIT INFO. G=rd SUlact <br /> Distance to sewer line gr= <br /> Domestic well on s" - (y/n) Z <br /> If yes, Iocation d distance - <br /> -i' <br /> V• O <br /> SAMPLING �1oraj <br /> sacicn <br /> Holding Temperature <br /> Method i <br /> Screening Me }` <br /> Trac kin tet (y/ n ) ' <br /> ft. tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Conti rm napon Noted - {y/n) <br /> Storage Location Casing type Z " PVC <br /> 131ankft- <br /> _ 3t7 _f r- Screen 10 <br /> Slot size f 02-, 0 <br /> GROUTING nags cement__ <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel �1 <br /> Mix Ratios Filter Pack type/size <br /> 4pstallation Method Surge Block: - ( y n <br /> Quantity Ins called Discussed with geologist: - (y' <br /> Type of method <br /> EH 29 29. . <br />