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MnNITORING WELL INSTALLATION REPORT <br /> Date: coNsTRUCTION <br /> Premise Address: s' �"�_ Total Depth <br /> Screen Length (from) (to) , <br /> Well No.: / � M� `y pl*/'p Filter Pack (from)_ j�- -._(to) .34; <br /> Bentonite (from) (to) <br /> Ins ector. Grout (from) 7 (to) <br /> P Drilling rig type ti — <br /> Permit No. Auger O.D. I.D. <br /> Completion . Stove pipe/christie boa (circle one) <br /> Consultant G <br /> Geologist ��S Gc.� <br /> stldt up <br /> T <br /> SPECIAL PgMT MO. SHE-GROUND CHAWN.$pX <br /> G COMPLETION SON <br /> Distance to sewer line Graud Surface <br /> Domestic well on site - / n) <br /> yes, location and distance - S cxA <br /> � e2 4r <br /> VA <br /> y 1{I <br /> tL <br /> �. <br /> b <br /> MWUNGi. .= • <br /> °G slDtud • ~ '� <br /> Holding Temperature moo 3 <br /> Method 44— rh"' <br /> pact <br /> Screening Method <br /> Tracking Sheet QjSn) <br /> .r}t. <br /> SPOILS <br /> Storage Method- MLTERIA-1SMEYUOPMENT <br /> Contamination Notes - (y/ n ) y��U <br /> Storage LocationD?�St�Ce - Casing e <br /> Blank ft. Screen to ft. <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite /0 s <br /> Bags sand/gravel- .1 fy <br /> Depth to water �7 , �` 91�O �Z/�`�` 8 Filter Pack type/ ' e G <br /> Mix Ratios _ Surge Block: - -Y n) <br /> Installation Method Discussed with geol g' t: / n) <br /> Quantity Installed Tyre of method <br />