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MONITORING WELL INSTAU AiZON REPORT <br /> CONSTRUCTION <br /> Date: <br /> r. <br /> Premise Address: Total Depth <br /> Length (gym) 2.F' (to) <br /> Filter Pack (from)Well No_: goemnirP (fMm)_ 7 Z_rto) <br /> Grout (from) <br /> Inspector. �. L' Drilling rig type - <br /> c� L c 2 Auger O.D. I.D. <br /> Permit No. Completion-Stove pipe/chrisde box (circle one) <br /> Draing Company: A <br /> Dr�31er: �_r ` he g r. <br /> Consultant <br /> Geologist 1 � ABCV_=-GRCUND <br /> CrlrP��3Cl�! CHFi1Si'Y-aCX <br /> GOtrEr''=i1CA! <br /> SPECIAL PERI—UT INFO. C�Sutace <br /> Distance to sewer line <br /> Domestic well on site - (y n ) 7 <br /> If yes, location and distance- .� fL <br /> r � <br /> a <br /> SAW I_NC uid <br /> acko <br /> Holding Temperature t cA <br /> Me*hod_ - <br /> Screening Method P l� <br /> Tracking Sheet - �y/ n) <br /> SPOIMS <br /> Storage Method rAN 0 �• y Mq•I•MIALS/I]EVELOPMENT <br /> Contamination Noted - y� n ? ; <br /> Bring t9Pe <br /> Storage Location <br /> ,., F <br /> Bek fL Screen ?o i fL <br /> Slotsize - <br /> GROLT 17NG Bags cement n , 4 <br /> Buckets bentonite -� <br /> Death to wale- 21) Bags sand/gravel -• <br /> t�, Filter Pack typesize a, ' _,7114, <br /> Mix Ratios r+-% -t < < n r � S Block- <br /> Installation Method �y/n ) <br /> d � �-�.; •�� -fi Discussed with geologist: - (y/ n <br /> quantity installe ) <br /> y Type of method <br /> sH 29 29 <br />