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MONITORING WELL INSTALLATION REPORT <br />Date:�TR�4 <br />Premise Address: <br />Well No.: L71n1 ' � ) nhl -�l t� `6Y, <br />Driller <br />Consultant T \� <br />Geologist3-u �e <br />SPECIAL PERNVL T INFO. <br />Distance to sewer line <br />Domestic we -11 on site / n ) <br />If yes, location'911-"'stance - <br />SANTLING <br />Holding Tempe arure of 1 r A <br />Method G "%ate /o <br />Screening Merhod1 <br />Tracking Sheet - y n ) <br />SPOILS <br />Storage Method J C 7C <br />Contamination Noted - rLn ) <br />Storage Location res� <br />GROUTING <br />Depth to water <br />Mix Ratios <br />installation Method <br />Quantity Ins alled <br />El 29 29 <br />CONSTRUCTION <br />Total Depth <�- is - <br />Screen Length (from)—+-(�(to) k <br />Filter Pack (from) (to) <br />Benroaite (from) (to) a!S <br />Grout (from) (to) -4-1 <br />Drilling rig type <br />Auger O.D. I.D. <br />Completion - Stove pipe/christie box (circle one) <br />casing <br />freight <br />ASCVE---RCUND <br />CCW'_= ON <br />Grxtc�" Svfan . <br />-M-3 —I <br />c <br />0 <br />tbBad — o <br />r <br />MATERIALS/DEVELOPMENT <br />Casing type -2- PV C— .� <br />Blank <br />- <br />Blank 3•i ft- Screen 10' fr <br />Slot size t7 <br />Bags cement <br />Buckets bemonire A If <br />Bags sand/gravel ^ <br />Filter Pack type/size 7i <br />Surge Block: - ( y /0 <br />Disarssed with geologist - ( y /D <br />Type of mehod <br />