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MONI'T'ORING WELL INSTALLATION REPORT <br /> 1 ' <br /> Date:_ 3 i.S'. I S' _ CONSTRUCTION <br /> Premise Address: 1 S ti CLA We-'Acf (-,cam-f Total Depth <br /> Screen Length (from) -(to) <br /> Well Na.: MW - `� ; W �t)-TWE W-f 0 Filter Lack (from)_ �_(to)— <br /> Bentonite (from) (to) _ <br /> Inspector; _ �,4i►.�nro. _ Grout (from) __-E) � <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company:- -- <br /> Driller:_ - _ �'l�x�_ Casing <br /> height <br /> Consultant %tcsl. nAC-1 -2-_-f-11 <br /> Geologist, )rJe ii a tA <br /> + ft —� A°AYE��CLlt�D C}-RSTY-BOX ' <br /> CONi'r'tE-DON <br /> SPECIAL PERMIT INFO. Cxc ri SLrtacq <br /> Distance to :ewer line <br /> qra <br /> Domestic well on site - (y/- <br /> If yes, location and dis ce - <br /> �ft. <br /> -4r <br /> v' m <br /> M <br /> SAMPLING :fat'wi <br /> sacicn �� � <br /> Holding Temperature _ <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ nCc) -" <br /> ft. tt. <br /> SPOILS <br /> Storage Method s-- "t 04"-Vk MATEWAIS/i?EVEE.OPMENT <br /> Contamination Noted - (y/n) , <br /> Storage Location Casing type Z V <br /> Blank q , fr. Screen S ft. <br /> Slot size 4 o Z 0 <br /> GROUTING Bags cement <br /> Buckets bentonite i— <br /> Depth to water Bags sand/graveI <br /> Mian Ratios Filter Pack type/size <br /> 4tstallation Method Surge Block: - <br /> Quantity installed Discussed vrith geologist: - (y, <br /> Type of rnallod <br /> EH 29 29 <br />