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- MONITORING WELL INSrALI.AMON REPORT <br /> Date: y <br /> COLMUCTTON <br /> Premise Address: 1 L �, <br /> �•ve Total Depth_ <br /> Well No.--Lw— Screen Length (from) <br /> Filter Pack (from) <br /> Inspector. i Bentonite (from) (toj__ <br /> n <br /> (from)__._,--Q-__._(to)_ b.a <br /> Permit No. Grout_. 4 I - 4 (� Dulling rig type 13 -<121 <br /> Auger O.D.�� I.I?..le_ <br /> Drilling Company; + Completion-Stove pip Iris (circle one) <br /> - Driller. �• <br /> casing <br /> Consultantheight <br /> N <br /> C��15U�-Tf�N TS <br /> Geologist F} <br /> ABOVE-GRCCM <br /> COWL ETION CKUM-8ox <br /> SPEG7AL- RMITTIN�F'O, COMPLETION <br /> " around S;aia <br /> Distance to sewer line lot) t <br /> Domestic well on site - (y 10-A <br /> If yes, location and distance- <br /> fL <br /> A Qft, tL <br /> f� Y <br /> AI LING :• �c <br /> alor — c <br /> Holding Temperature ° aecicn = .$ <br /> Pte. Method <br /> r g"IW� <br /> e Screening Method u . <br /> �a Tracking Sheet <br /> - (Q/n} <br /> — <br /> 1 sem; POILS --�• Z a� O fL <br /> Storage Metho6e* ion;4e pyvg <br /> d„ <br /> Contamination Noted . (y/Qj R.IAI.SEWLOPMENT <br /> Storage locationLie <br /> _ <br /> BBlank' <br /> Wev <br /> (L Screen l S;tj fL <br /> G QL NG Slot size 1 �, <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> mix Ratios + Bags sand/gravel <br /> Installation MethodFilter Pack type/size•_, � <br /> #Quantity Installed 79ML.441 Surge Block: - (m/n ) <br /> ,�.. Discussed with geologist: - ( /n) <br /> t 29 29 Type of method <br /> E ttvt <br /> F <br />