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MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> CONSTRUCTION <br /> Premise Address: q l <br /> Total Depth � 1 <br /> Well No.: hA LA2 — I p I Screen Length (from) —' (to) <br /> Filter Pack (from) —(to)� <br /> Inspector- Bentonite (from) (to)__Tt'4L_5; <br /> Grout (from) <br /> Permit No. Z c. Dulling rig type <br /> Auger O.D. I.D. <br /> Drilling Company: \)4L-_) L 1 4. Completion - Stove pipcasing <br /> chris[ie box (circle one} <br /> height <br /> I <br /> Consultant <br /> GeologistAA Ai BO _QV <br /> AVE-GFCUND <br /> C 0kFLETICN C�_SM Y-a0X <br /> SPECIAL PERMIT INFO comPuncN <br /> C3+•ourid Surf.�ct <br /> Distance to server line grout <br /> Domestic well on site (iZ.,S ft. <br /> If yes, location an 'stance - <br /> -66.5- <br /> I. <br /> v m <br /> w <br /> SAMPLING — — C <br /> RIOr.�.i C <br /> taticn <br /> Holding Temperature aL:E CA <br /> MethodIs <br /> tr"�Y91 F-ack <br /> Screening Method P1 i1 <br /> Tracking Sheet V n ) _ <br /> �• .w • tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) - <br /> Storage Location <br /> -e?.d I..st-ii ...._ 1. -Vir,_ Casing type 2 <br /> Blank_ . �jg _fr. Screen 2 <br /> Slot size 1070 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water N ags sand/gravel z <br /> Mix Ratios Filter Pack type/size <br /> S <br /> Installation Method urge Block: - ( y/ ti } <br /> Quantity Installed Discussed with geologist: - ( y/ n } <br /> EH 29 29 Type of merliod <br />