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MONITORING WELL INSTALLATION REPORT <br /> J <br /> Date:— I f I O 1 <br /> CON�C-ION <br /> Premise Address; � 7j y � <br /> Total Depth t <br /> Well No.: {13 (�1— 7 Screen Length (from) z <br /> Filter Pack <br /> (from) <br /> Inspector-. �1.. . . Bentonite <br /> (from) (to)�o / <br /> Grout <br /> Permit No. (from)-- (to)�` <br /> .Drilling rig type <br /> Auger O.D.__� I.D. <br /> Drilling Company; Completion - Stove pipe/cluistie bo— <br /> ��`� (circle one) <br /> Driller- <br /> Consultant r7 casing <br /> height <br /> Geologist <br /> fn------r--- .- T' <br /> �1.°CVE�ACUND T <br /> SPECIAL, PERMIT INFO. CCMPLETCN �u7Y30X <br /> Cxound Suiacy T <br /> Distance to server line r <br /> ElOcation <br /> tic well ncN <br /> on site - (y/ n grout <br /> and dist <br /> SANG <br /> c <br /> +IotAi <br /> Holding Temperature <br /> Method qtr o '-+ $ <br /> �`� (� sec7cn - — <br /> Screenir ne[hod gnvdyact <br /> Tracking Shcet _ kD ) <br /> n <br /> SP— <br /> tt. <br /> Storage Method�l��L <br /> p <br /> Contamination Noted MATER.IALS/DEVE[OPMENT <br /> Storage Location (1Y n <br /> Casingtype <br /> —a PLIC` <br /> GROU Blank �Z Screen�l _fr <br /> Slot size 07-0 <br /> Bags cement <br /> Depth to water ' Buckets bentonite_1 _ <br /> Mix Rarios Bags sand/ <br /> Installation Method gravel <br /> Quanti Filter Pack type/size <br /> ry installed ^ Surge Block: . <br /> EH �9 29 u --- Discussed with geologist-. - (y <br /> Type of method <br />