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MONITORING WELL INSTALLATION REPORT <br /> Date:_ [_I(I �j 0,;- CONSTRUCTION <br /> Premise Address: W N i (` l \C46 A )6 Total Depth <br /> / Ci Screen Length (from) (to) <br /> Well No.: 7,AJ-tC r rr P- �� Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. ly�C- L' Grout (from) (to) <br /> Drilling rig type' <br /> Permit No. Auger O.D. I.D. <br /> p Completion - Stove pipe/cltristie box (circle one) r <br /> Drilling Company: IAJUK WCr <br /> Driller: p <br /> Consultant ULfL S <br /> Geologist ,SC.�i ( eek v , <br /> • grout <br /> _ <br /> to <br /> SPECIAL PERMIT INFO. 4 seal <br /> Distance to sewer line <br /> Domestic well on site - ( I ) <br /> If yes, location and di nce - <br /> gravel pack <br /> SAMPLING seal <br /> Holding Temperature �ft, <br /> Method i wv'rn C V'- <br /> Screening Methodft; <br /> Tracking Sheet - (y/ n ) gravel pack <br /> SPOILS 7., <br /> Storage Method P1 MATERIALS/DEWLOPMENT <br /> Contatnlnadon Noted • n U Pny 00 Kn�5-j�kf A <br /> Storage Ipcadon r ( •gyp , Casing type 1 — <br /> Blank fc. Screen K• <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water NL3 Bags sand/gravel <br /> Mi:t Rados Filter Pack type/size <br /> pstalladon Method Surge Block: - (y/n) <br /> Quantity installed V Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29.29. . <br />