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MONITORING WELL INSTALIAMON REPORT <br />Date: ✓� / ( 1�' O <br />Premise Address:2glp,`L _333on) a bmti<km <br />Well No.: <br />Inspector. n C <br />Permit No.--C� KO — <br />Dnlling Company: f �n r ecb ti <br />Duller. <br />Consultant <br />Geologist <br />SPECIAL PERIVE INFO. <br />Distance to sewer line <br />Domestic well on site - (y / <br />If yes, location and ' e - <br />SAMPLING <br />Holding Temperature nv. u-- -- <br />Method CrwH 6l 0,0 -- <br />Screening Method N7 <br />Tracking Sheet - n) <br />SPOILS <br />Storage Method 0,- <br />Conrammarion Noted - ( y / <br />Storage Location O^ t\ ( ^V�'- <br />GROUTING <br />Depth to water <br />Mix Ratios <br />Installation Method - <br />Quantity Installed <br />EH 29 29 <br />CONSTRUCTION <br />Total Depth HS <br />Screen Length (from) 30' (to) `1 <br />Filter Pack (from) 2,1&-( (to)_f <br />Bentonite (from) i (a . (to) LSr <br />Grout Cfrom) z (to) Z6 <br />Dulling rig type <br />Auger O.D. LD - <br />Completion - Stove pipe/chrisde box (circle one) <br />casing <br />he; <br />ABCVSvACUND <br />=hWv? fSON <br />��� Gr�urE Strtact s <br />grout <br />y 2L <br />L tS Z. <br />_ o <br />tbitad — m <br />2val ?acx <br />MATERIALS/DEVELOPMENT <br />Casing type Z -CVC <br />Blank 2 c, fL Screen ! i fr- <br />slotsize -6zo <br />Bags cement <br />Buckets bentonite 1 <br />Bags sand/gravel <br />Filter Pack typesize t. 3 � <br />Surge Block - ( y / n ) <br />Discussed with geologist - ( y / n ) <br />Type of me -hod <br />