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MONITORING WELL INSTALZPTLON REPORT <br /> CONS <br /> Date: �7� Total Depth- <br /> Premise <br /> eP� <br /> Screen Length (from) (to) <br /> Premise Address: 1 Filter Pack (from)-----(to) <br /> yww Bentonite (from) <br /> p Inl ' 3 (from)_---R°)--Well No.: , I Grout <br /> 4d' <br /> Drilling n8 tYPe Inspector. Auger Auger <br /> D� Completion - Stove pipe/chrisne box (cine one) <br /> Permit No. Se- <br /> J <br /> Drilling Company Gx pnA ` — W'V <br /> casing <br /> Driller: he, <br /> Consultant <br /> Xj;;VE-GRCUND Grw srr dCN <br /> Geologist <br /> CONVLETVON CCMPLET1 <br /> —„�Orwnd Stslact �-r�'� <br /> prat <br /> SPECIAL PERMIT INFO' <br /> Distance to sewer line / <br /> Domestic well on site - (Y/ n) S tt _ <br /> if yes, location and distance , <br /> O <br /> -- CO <br /> ilOn� '9 <br /> soricn <br /> SS Sr1Y9I P'<X <br /> Temperature <br /> 5,! <br /> Holding Temp — <br /> Method— 7.1' <br /> Screening Method 1��'\-- <br /> Tracking Sheet (Y/ n) tt. -- — <br /> SPOILS �..Ten r nt S/DEVELOr PMEN C <br /> Storage Method Cys g type ?- VdU <br /> Contamination Noted- (Y/ n) Screen ^ �1y I� I <br /> Storage Location Bl���— <br /> Slot size <br /> Bags cement <br /> y EuckeBucketsbentonite t <br /> Bags sand/grav <br /> GR�NG el <br /> Filter Pack type/size <br /> Depth to water Burge Block: - (y/ n) <br /> Mix Rados vr <br /> ei <br /> d th geologist: - (Y/ n) <br /> ,installation Method Type Discussed <br /> Wirod <br /> Quantity installed <br /> EH 29 29 <br />