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1 - MONITORING WELL INSTALLATION REPORT <br /> Date: I eI. :ZfS 0(j CONSTRUCTION I <br /> Premise Address: zoSS --1toA0,L� t2ndJ ) Total Depth /00 <br /> Well No,: Screen Length (from) `i S (tO)- yp' <br /> _ , <br /> yL1Q) � � Filter Pack (from) 4y�(to)- �p <br /> Inspect or, drd` Bentonite (from)- go] (to)_ !12,1rua Grout (from) c3 (to)_ ;q / <br /> Drilling rig type <br /> Permit No. ZpS� <br /> �" Auger O.D. I.D. <br /> Completion -Stove pipe/clu-istie box (circle one) <br /> Drilling Company: ln�r'ior:UWd�� • <br /> Drillercasing. <br /> Consultant_ -TL°_ _ 1 height <br /> Geologist_ Tr7G/.�,r�erw� <br /> • Dove-GacuND <br /> COWL TION GAsIY30X <br /> SPECIAL PERMIT INFO. ��9�sfxe CG144'L-'MN <br /> Distance to sewer line 0r«a <br /> Domestic well ons• - (y/n) —It <br /> If yes, locado d distance - <br /> C <br /> SAMPLINTG' / <br /> tacit <br /> Y �Ot�.�y. aocicn <br /> Holding Tempera <br /> Method <br /> Screen' ethod ' —1 J <br /> Ya,cFAngSheet - (y/ n) <br /> SPOILS <br /> StorageMethodd� ne, MATERIALS/DEVELOPMENT <br /> Cont4m[nadon Noted - <br /> Storage Locadon rn/,si l& Casing type 2 <br /> Blank / : fr. Screen efS'- fc• <br /> Slot sizey'2 O <br /> GROUTING Bags cement N <br /> Buckets bentonite / mac <br /> Depth To water N S Bags sand/gravel n,6 <br /> Mix Rados (te .,,( ( � (� C(' Filter Pack type/size 3Z s. were c s�u,e� <br /> -installation Method -Q�� Q�,�t �11vw C1 jM41 Surge Block: - <br /> (y n <br /> Quantltyinstalled_ Tnl1gd —a Discussed vrith geol ist: - (y/ <br /> Type of method <br /> EH 29 29. . <br />