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MONITORING WELL.INSTALLATION REPORT , <br /> ` v Date: CONSTRUL-nON <br /> Premise ?address: i 3 �-c Total Depthw 7-S- <br /> V- <br /> -S .� <br /> s Screen Length (from) .(to) <br /> WeU.No. �M Imo" -- 41 Filter Pack (from) -- - -- (to) ' <br /> " " Bentonite F (from) 51' (to) ' <br /> Inspector. •- r - Grout (from) S ' (to)_ <br /> 'Drilling rig type- ­.1. <br /> Permit No. C) °� d , �' Auger O.D_f5 yl i" I.D. <br /> Completion-StoveStove pipe/chrisde bog (circle one)-- <br /> .Drilling Company: 1j+W Adb4l`� <br /> cas_n <br /> Driller: �L 31 1i " � � 't <br /> g <br /> - - .-. - " "...`.. ' � 6� <br /> .neigh '.-.- <br /> -_: <br /> Geologist . a.+� o4,61AQIM Q,Rr <br /> SPECIAL P£RC?T INFO. f:cocsr5�xlaca . <br /> _ r � <br /> Distance to sewer line " <br /> Domestic well.on site - (y/ n)._ ! S <br /> If yes, location and distance - 73 <br /> - <br /> - moi.: • �„- m <br /> ` - Y- •ww . _ .:r. +wMl-'+Y Y-.M..4n . I .. r. S �• � a .. ..n.- ,s-. � <br /> SA VIPLING ti _Wcasd <br /> Holding Temperature rnA — „vi pack - <br /> Method <br /> Screening Method P I(7 <br /> Tracking Sheet. - 9y/ n ) 1" _ <br /> tL <br /> SPOILS - • .-...--»,.......r.,..,._�` _y.. ... ._� ,k.,.,.,..;�_. ..�:....,.,..:.„. „ .. ,....�., ..,.-..-._.�., _ -- . �. _. .. - .a. . .. ... <br /> Storage Method '� `MATERIAL S/DEVELOPMENT. -- �- <br /> Contamination Noted - n ) <br /> Storage Location„ �r - ."y -Casing type Z!, Pu L <br /> f Blank SS m Screens_ 7_O fr <br /> ,S10tsize- - Q.260 y . <br /> GROUTINGBags cement 4- <br /> Buckets bentonite - <br /> .Depth to water N BagsC�gravel n., � <br /> Mix Ratios Filter Pack tyWsize <br /> Lnstalladon l4ethod Surge Block: - L 1 ro { <br /> Quantity Installed Discussed with geologist: - C y/® <br /> Type of method Vo7re., x ~ - <br /> EH 29 29 <br /> . • I1 <br /> _ r.R.rwa�;-. .. rte,.•. r. r s :- ! <br />