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MONITORING WELL INSTALLATION REPORT <br /> �7gyi �Oo� CONSTRUCTION <br /> Date: <br /> led <br /> /6�/ <br /> d/� /C Total Depth <br /> Premise Address: — Screen Length (from) (to) <br /> well No.: aS Z/ p 2- (1 07- 2 Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> �J/ Grout (from) (to) <br /> Inspector. / / r� p/, Drilling rig type 490 lP ! 9 F Se DOy/ls Ov Auger .0.13 I.D. <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company <br /> casing <br /> Driller. he_ght <br /> Consultant C5 f <br /> Geologist /G z{ ABOVE.GSCUND CNR:StY-3CX <br /> COYFLEMN C;q!A?t_-T1CN <br /> ��.�. G=r)d Sirtacy <br /> SPECIAL PERMIT INFO. <br /> Brat <br /> Distance to server line ___.(!, <br /> Domestic well on site - (y/ n) g- <br /> If yes, location and distance - <br /> I0 <br /> c <br /> _ o <br /> SAMPLING socicn — <br /> _ _ grand Fzdc <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Sheet - (Y/ ) tt = �_tt• I <br /> Tracking n arl <br /> SPOILS �Rfi,��ar�uf �'e� s/� --��Z cow✓�k� <br /> MATERI ALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted- (y/ n) Casing type K <br /> Storage Location Blank ft- Screen__ <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> IIagssand/gravel — <br /> Depth to water Filter Pack type/size ---------- <br /> Mix Ratios Surge Block: - (Y/11) <br /> ,Ipstallation Me[hod Discussed with geologist: - (y/ n ) <br /> Quantity installed Type of nethod <br /> EH 29 29 <br />