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MONITORING WELL INSTALLATION REPORT <br /> Date: t I D 5' CONSTRUCTION <br /> �1 ( <br /> Premise Address:- Total Depth 1i 1 <br /> Screen Length (from) (to) <br /> Well No.: S -11 P-1 1 1---Ld-I4SP-12 Filter Pack (from) (to) <br /> $entonite (from) (to) <br /> Inspector, V).6 «• Grout (from) Fi (to) +0, <br /> Drilling rig,type <br /> type' <br /> Permit No. Auger O.D. 10 " I.D. <br /> /J Completion - Stove pipe/cluistie box (circle one) <br /> �f70n�t )rnnofT <br /> Drilling Company In <br /> Driller: mot Ifo i ,� h�tl <br /> Consultant YZ- - <br /> Geologist -5'rCq , 1Z?V ;!1111 grout <br /> jo^ft. <br /> SPECIAL PERMIT INFO. seal <br /> Distance to server line <br /> Domestic well.on site - y^/ n) <br /> If yes, location istance - gravel pack <br /> gr <br /> ZSR. <br /> SAMPLING seal - b<KA"tt✓ <br /> Holding Temperature {�+ _-__ _ _ _ _ ft <br /> Method_f tdYc�, .Un- Y Wf.( agAoo�• - <br /> Screening Method 4�ft: <br /> Tracking Shcet - (y/ n) gravel pack <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Cent4minadon Noted - (®' n) <br /> Storage Location fnd51 Casing type ( t` ' f - t�VC fr <br /> Blank ft. Screen — <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite a A <br /> Depth to water N 2 3 Bags sand/gravel <br /> MIX Rados Filter Pack type/size �� /xAda <br /> 4pstallation Method VIA A Surge Block: - (y/V <br /> Quantity installed T- Discussed with geologist: - ( y/G) <br /> Type of method <br /> EH 2929. . <br />