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MONITORING WELL INSTALLATION REPORT <br /> Date:_ 29 I.Q F, CONSTRUCTION <br /> Premise Address: Total Depth r! S <br /> Well No,:_ /,��— — _ Screen Length (from) �1 L (to)- i,6- 1 , <br /> —� — Filter Pack (hom) r(to)_ 1 E <br /> w'"-'y Bentonite (from) LSs` (to) <br /> _6v� _ I b <br /> Inspector. _ 1�[AA^'cr. e_ C" w r/. Grout (ham) (to) lir <br /> Drilling rig type <br /> Permit No. A 1z-C)5 Auger O.D. I.D. <br /> c ,Cvr/ I Completion - Stove pipe/duistie box Wrde one) <br /> Drilling Company: �Oan _ ' <br /> Driller: casLng- <br /> ^ height <br /> Consultant /QT'S Cb IFn-1 V + <br /> nn �� . <br /> Geologist_ ` <br /> • A.pAVE-GRCtJND <br /> COh�LETfoN C}�AlSTy-39X ' <br /> COMPLEncN <br /> SPECIAL PERMIT INFO. mrd SUri <br /> Distance to sewer line praK <br /> Domestic well on site'- /n) <br /> If yes, location an stance - L3 <br /> f _ <br /> - C <br /> SAMPLING <br /> �lorad � <br /> socicn <br /> Holding Temperature <br /> Method -= — <br /> Screening Metho — <br /> Tracking Sh (y/ n ) -f'4- - <br /> Sp IS <br /> Storage Method vl tnw MATERIALS/DEVELOPMENT <br /> Contamination Noted . (y n <br /> Storage Locadon Casing type "p <br /> Screen p h. <br /> Slot size oz-& <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel - <br /> Mig Rados Filter Pack type/size 3?Stn ri _ <br /> -installation Method Surge Block: - (y/n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29. . <br />