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MONI'T'ORING WELL,INSTALLATION REPORT <br /> Date: b �, <br /> CONSTRUCTION <br /> Premise Address: s <br /> Total Depth 1 <br /> Well No.: Screen Length (from) ([o) a <br /> Filter Pack (from) (ta} <br /> Inspector. Benronite (from) (to)- <br /> Grout (from) -ems- (to) ` <br /> Permit No. 3 L Z,CL Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company; Completion - Stove pipe/christie box (circle one) <br /> Driller. <br /> casing <br /> Consu]tant hel ght <br /> 4 ,q► <br /> Ceologist <br /> SPECIAL PERMIT INFO. CONPL'`T1CN Ci-A:STY3C}X <br /> Cra M 5csisca cOMPt_R7CN <br /> Distance to sewer line <br /> Domestic well on site ,,,. (y 111 yrwt <br /> i11 <br /> f yes, location and dis` ce - <br /> 1,� y <br /> SS A <br /> c <br /> Holding Temperature G sodenMethod If <br /> Screenin;Method _r — p�vclF"CR <br /> Tracking Shcet (y/ n) . <br /> SS PALS <br /> Storage Method 'j ,j <br /> Contamination Noted( n MATERIALS EVEI.OPMENT <br /> Storage Location <br /> Casing type <br /> Blank ft; Screen <br /> G-- NG Slot size Z <br /> Bags cement, <br /> Depth to water /L/ ' Buckets bentonite <br /> Mix Ratiosz. Bags sand/gravel 71Jr <br /> lnstalladon Method Filter Pack type/size 3 <br /> Quantity Installed 1 Surge Block: - (y/�t <br /> Discussed with geologist: - {y 40 <br /> EH 29 29 Type of method <br />