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MONI 170RING WELL INSTALLATION REPORT <br /> TO- C(, <br /> -r w-4 <br /> 2 Tw 7 <br /> Date: � �- /-13 <br /> CONSTRUCTION <br /> Premise Address:_ �(1 �9 <G�3 IlI�'O Total Depth <br /> Well No.: 7 �Y Tk75 (o�yTlJ7 Filren Lete Pack (from) /S (to)�_ <br /> Inspector: J' yKol Bantonite', (from) t (to)z3 <br /> Grout (from) (to) <br /> S (�7 / , Drilling rig type mer <br /> Permit No. Auger O.D. I <br /> Drilling Company:. t) f Completion- Stove pipe Christie box circle one) <br /> Driller: OW6 <br /> � pp�� casing <br /> Consultant_ i�46)UlY/JY{ height <br /> VM <br /> Geologist <br /> ABOVE-GROUND <br /> GRcwA�pagPgt` cawLET1oN CHAIsN-BOX <br /> SPECIAL PERMIT INFO Ti`'�P r7vw �PaW 1X COMPLETION <br /> C3rcund Surixe - <br /> Distance to sewer line grout <br /> Domestic well on site • /n) <br /> If yes, location an stance - h- <br /> - <br /> SAMPLING <br /> gicttad - <br /> Holding Temperature aec4on a — <br /> Method :3,.Y = grAVO pack <br /> Screening Metho <br /> Tracking She - Cy/n) <br /> SPOILS <br /> Storage Method MATE1tIAIS/DEVELOPMENT <br /> Contamination N ed- (y/n) <br /> Storage Loca ' n µ!-r 4/0 <br /> Casing type 115 p Mt;D <br /> Blank !S ft. Screen /6-25" ft. <br /> GROUTING Slot size U 10 <br /> Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel- <br /> Installation Method <br /> Mix Ratios Filter Pack type/size <br /> Quantity lnatalled Discussed with geologist: - (y/ V4 <br /> Eli 29 29 Type of method <br />