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MONITORING WELL INSTALLATION REPORT <br /> Date:_ /l7-f b� . CONSTRUCTION <br /> Premise Address: a" S�^ Total Depth /s <br /> rScreen Length (from) <br /> Well No.: M`� _ W-/7 .-- -- <br /> (to)ePack (from) (to) <br /> Bentonite (from) S <br /> Inspector., Bnt om) (to)'/d [�n�s t Grout (fr m S/ (to) rr� <br /> Drilling rig typr L. <br /> Permit No. Auger O.D. R I.D. <br /> v S Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller• casing. <br /> height <br /> Consultant / '4' <br /> Geologist_ /OkAt1 Lelr�4 ` <br /> T • AzovEGRcuND <br /> OOWL_ErION At5TY30X <br /> COt,1?I��TICN <br /> SPECIAL PERMIT INFO. Gcund Suiacr <br /> Distance to sewer line oKc <br /> Domestic well on site.- (y/n) <br /> If yes, location and distance - 3 <br /> �S fi. ft. <br /> V O <br /> SAMPLING A'14 <br /> �lorai �i — c <br /> soden , <br /> HoldingTempe dture <br /> Method — 7"-"Pack <br /> Screening Wthod <br /> rv?` <br /> Tracking cet - (y/n ) <br /> SPOILS n <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y ) z 'Jpw <br /> Storage Location D7.• sr Casing type <br /> Blank -LO ft Screen h• <br /> Slot size O10 <br /> GROUTING Bags cement 7 <br /> i Buckets bentonite IIJ <br /> Depth to water lit _ Bags sand/grave 11, <br /> Miz Rados Filter Pack type/size <br /> ,Installation Method il_1a . Surge Block: - (y/u <br /> Quantity installed Discussed with geologist: - (y/CIP <br /> Type of method <br /> EH 29 29. . <br />