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t 1 <br /> MONITORING WELL INSTALLATION REPOni <br /> Date : j< � > CONSTRUCTION <br /> � p- I e <br /> Premise Address : 1/536 W- is Total Depth ( � / <br /> Screen Length (from) !D (to) / Zo <br /> Well No. : Filter Pack (from) / 06 (to) 12, 1 <br /> Bentonite (from) ! U L (to) / 06 <br /> Inspector: C44 Grout (from) to y (to) o <br /> C Drilling rig type M11P <br /> Permit No. J 2 �7i Auger O.D. /(o/ !2 i 6 I .D. <br /> �- Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: L'eUlLtio( /G ` <br /> Driller: Nzztc f /2 �t k�Cc t hie <br /> Consultant 'i;f / - <br /> Oo <br /> Geologistrr . <br /> 68se <br /> LLi i <br /> SPECIAL PERMIT INFO . <br /> 470 <br /> Distance to seau*PqtE <br /> Domestic well on site - y n ) 162, <br /> If yes, location and distance - + <br /> = �o too /lo tt. _ tt. <br /> SAMPLING slotted <br /> section —_ <br /> Holding Temperaturegnve�= P <br /> ack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - ( y / n ) �ZU <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ®n11 <br /> ) / <br /> Storage Location 6� �o-� Casing type 2 ,34X 40 <br /> Blank & D ft. Screen_ t o ft. <br /> Slot size o2_U _. <br /> GROUTING Bags cement <br /> pp / Buckets bentonite / 7X•10 _ <br /> Depth to water iJ Bags sand/gravel t 250 LG- <br /> Mix Ratios 7 t 9'd " 74ct ot ✓ Filter Pack type/size <br /> Installation Method a- end Surge Block: - (D n ) � <br /> Quantity Installed Discussed with geologist: - ( y On <br /> Type of method <br /> EH 29 29 <br />