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i / Mr" ITORING WELL INSTALLATION REPORT <br /> Date : 9Z CONSTRUCTION <br /> y N, �Pc <br /> Premise AddrA9Dl <br /> ess : �� Total Depth 715 <br /> Screen Length (from) (to) <br /> Well No. : �� y 8 ' Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type CSG & <br /> Permit No . 9z - a ,z33 Auger O.D. /D I.D. S y r <br /> /9 Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: i%Le <br /> l casing <br /> Driller: height <br /> D <br /> Consultant //� 4 " <br /> Geologist Ci[ 4� �[ 13��LC ABOVE-GRCUND <br /> CUM?LFrCN - CFiRISTY30X <br /> Ground Surf <br /> SPECIAL PF_RMIT INFO* <br /> grout <br /> Distance to sewer line d D %6�6/Z ft <br /> Domestic well on site ( y / n <br /> If yes, location and distance - tt <br /> �5 n. <br /> . = a <br /> _ o <br /> slotted = c <br /> HoldingTemperature /VO. ° - � Pn) pac'c <br /> Method <br /> Screening Me -od /D <br /> Tracking Sheet - y n ) <br /> SPOILS f� / <br /> Storage Me hod Uk, t �'�"1 `�� ` MATERIALS/DEVELOPMENT <br /> Contamination Noted - n ) yd�cs(jCJ �"—/ S3® (ad /� � a Scei �� 0✓ � <br /> Storage Locarion O>t UJ Casing We <br /> Blank 5 .5 fr. Screen ZO ft. <br /> Slot size • O Z <br /> GROUTING Bags cement if TtC LfW 1 <br /> // Buckets bentonite Z <br /> Depth to water ^ Bags sand/gravel 6 2 <br /> Mix Ratios Lf r 31 be• 44 Filter Pack type/size of 451 <br /> Insmilarion Method —( .ice Surge Block: -C y n ) <br /> Qua city Installed ll (I Discussed with geologist: • n ) <br /> Tope of method /� C7r !% )2e) i /fat <br />