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MONITORING WELL INSTALLATION REPORT <br /> Date: l 1 b 5- CONSTRUCTION \ <br /> Premise Address: �i I � MW Total Depth <br /> Screen Length (from) (to) <br /> Well No.: -3 tS P-72 = -S3{�- S Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector, CO t--- Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> p0 -- Completion - Stove pipe/christie box (circle one) c <br /> Drilling Company. (�oyGt <br /> Driller: /�'tnnao�rrl, <br /> Consultanty tlL�i <br /> , f� <br /> GeologistSCG' 4 <br /> grout <br /> seal <br /> SPECIAL PERMIT INFO. <br /> Distance to sewer line Lft' <br /> Domestic we>an <br /> - ) <br /> If yes, locatiCance - i gravel pack <br /> aft. <br /> SAMPLING - 1'- seal <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) gravel pack <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( n) <br /> Storage Location &V"—, r tic Casing type `PVL`— �} <br /> Blank fc Screenft. <br /> Slot size <br /> GROLMNG Bags cement <br /> Buckets bentonite <br /> Depth to water ^' 2 2 -Z S Bags sand/gravel <br /> Mig Ratios Filter Pack type/size 1 350. <br /> 4gstallatior Method _..0 ,✓ Surge Block: - (y <br /> QuantiryInstalled Discussed vrith geologist: - (y/ n ) <br /> Type of method <br /> EH 2929. . <br />