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MONITORING VELI,INSTALLATION REPORT <br /> Dace:_ CONSTRUCTION <br /> Premise Address: b b Z_ ( /�,,�„ _ j; <br /> Total Depth S <br /> Well No.: ryl Ial _ ' (+ Screen Length (from)_ I? _(to) 35 <br /> Filter Pack (from)_ 12- (to)_13 g <br /> In spector. _ ,� Bentonite (from)_ 11 <br /> Grout (from) (to)_II� <br /> Permit No. Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company:`(�n,'��t�� Completion - Stove pipe/christie box (circle one) <br /> Driller: <br /> casing <br /> height <br /> Consultant + <br /> Geologist <br /> AZOVE-G R CUND <br /> COA rPL_E ON C�-ACSTI'30X <br /> SPECIAL PERMIT INFO C =CCN <br /> C�Ourxf Su-tacs <br /> Distance to server line grout <br /> Domestic well on site - (y/ <br /> If yes, location and dist e - " It• <br /> h. R' <br /> v' m <br /> - w <br /> SAMPLING — C <br /> 0 <br /> tloroi :%i '— c <br /> so-cicn = <br /> Holding Temperature <br /> Method p avert;adt <br /> Screening O#drod = _ <br /> Trac hcet (y/ n ) <br /> �• J4 rtt. <br /> SPOILS <br /> Storage Method A A MATERIALS/DEVELOPMENT <br /> Cont4mination Noted - n) <br /> Storage Location_ m,� •5 rf Casing type- - z ' fV Y _ <br /> Blank f Screen fr• <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water ^�`-1 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> ,-Fnstalladon Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n_ ) <br /> Type of method <br /> EH 29 29. . <br /> 1r ./ <br />