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MONITORING WELL INSTALLATION REPORT <br /> Date: C2 CONSTRUCTION <br /> Premise Address; <br /> --�•-2, "�� 4�r'e^.1L4.��i.., Total Depth_ <br /> Well No.: <br /> Screen Length (from) T (to) <br /> -4W <br /> Filter Pack (from) D (to)� - _ <br /> Bentonite (from) <br /> Inspecto (to) <br /> r, �~ <br /> Grout (from) <br /> Drilling rig type <br /> Permit No. ��] Auger Q.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/clu-istie box (circle one) <br /> Driller_ casing <br /> Consultant <br /> 7_ he=ght <br /> Geologist T <br /> ABOVE-GPC(ND <br /> GOWLErION C}�JSTY-2OX <br /> SPECIAL PERMIT INFO. CDNPt_=nCN <br /> C=nd Surfacs <br /> Distance to sewer line <br /> Domestic well on site - ( ) grout <br /> If yes, location and di nee - <br /> g' f t. <br /> Win. 6© ft. <br /> SA—PU G o <br /> C <br /> alored a <br /> Holding Temperature — <br /> Method sac�cn = <br /> Screening-Method'-- 73 VW Fac <br /> Tracking Shcet -�y / ) — <br /> n <br /> 99 <br /> t1. <br /> Storage Method $-S" <br /> Contaminatiorz Noted . <br /> Storage Location C Y/n MATERIALS EVEI Op�N.i, <br /> Casing type Z,`• <br /> GRU NG Blank fG <br /> SIot size Screen-____��_j mfr, <br /> Depth to Water Bass cement <br /> Mix Ratios .v 1 Buckets bentonite <br /> Install atiOn Method ff2Ca <br /> Bags sand gravel ct <br /> Quantity Installed Filter Pack tYPc/size <br /> 0 Surge Block: - (y <br /> EH 29 29 Discussed with geologist: - (y/n ) <br /> Type of method <br /> J <br />