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MONITORING WELL INSTALLATION REPORT <br /> Date: l c'D/ ( � I D �'1 CONSTRUCTION <br /> Premise Address. AO 1 ! Total Depth a 6 <br /> Screen Length (from) r-> (to) d S <br /> Well No.: PA Filter Pack Com) (to) <br /> Bentonite (from) (to) <br /> Inspector: butAArn t Grout (from) (to) <br /> Drilling ng type <br /> Permit No. Auger OJD' lam' <br /> Completion-Stove pipe/christie hoz (circle one) <br /> Dulling Company: rM\B ,n.� <br /> Driller — casgaq <br /> height <br /> Consultant G/�o� Fly�/� ♦ 77 � <br /> Geologist C ,�-�c, � � - W <br /> AWYE-GRCUND SSS T Y-c3CX <br /> G."tirP:�`T''CN C.'�triP_=,ICN <br /> SPECIAL PER- i INFO. d 'c' A <br /> Q� <br /> Distance to sewer line <br /> KIA <br /> Domestic well on • (y/ n ) <br /> If yes, Iota ' and distance - - ��—tL <br /> C <br /> SAIvL4l..ING � — o <br /> Holding Temperzture <br /> Method _— <br /> Screening M r d _ <br /> Tra�kin eer - C y/ n ) 1 __ <br /> IF _ ♦ Z-� n- <br /> SPOILS <br /> Storage Method (1A,\ k IAA/*,-- MATERIALS/DEVF.LOPN= <br /> Contamination Noted - C y/ n 1., p <br /> Storage Location nom, � Casing type Z I <br /> Blank l a fr. Screen 15� fc <br /> Slot size c> <br /> GROLTI-LNG Bags ce �Me=onire/- <br /> - y <br /> Buckets Depth to aarer Bags sand/grave-1 <br /> Mix RatioN Filter Pack type/size-2- <br /> Surge <br /> ypesize Z �ssdao <br /> Installatiorhod Surge Block_ - (y <br /> Quantity Installed Discussed with o <br /> Type of method <br /> EH 29 29 <br />