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MONITORING WELL INSTALLATION REPORT <br /> Date:_ CA (v CONSTRUCTION <br /> Premise Address:_ Z,045'Z,045' Total Depth 6D i <br /> Screen Len ` <br /> Well No.: yYl W- )zi Length (from) � - (to)A,Filter Pack (from) � Z (to)_ <br /> Bentonite (from) 3 Cl (to) y <br /> Grout, z r <br /> inspector. (nnn[o Grou <br /> (from) <br /> Drilling rig type <br /> Permit No. a�7�0 > Auger O.D. T.D. <br /> ^ Completion - Stove pipe/cl�ristie box (circle ane) <br /> Drilling Company: �OQ��/i <br /> Driller: "C4„ / casing- <br /> /� he_ght <br /> Consultant_ ( r S y <br /> Geologist 60ln1,- \ <br /> tM — AWVE-GR-0JND <br /> COWLE ON C}-RtSTY-30X <br /> SPECIAL PERMIT INFO. - G=rd gLT12.cy CCMir'LE PON <br /> Distance to sewer line Orx: <br /> Domestic well o ' e: (y/n) It <br /> %ryes, lot and distance - <br /> _ti n. a n. <br /> 0 <br /> SAMPLING <br /> ,IoCvd <br /> soc'cn - — <br /> Holding Temperature = �� <br /> Method — <br /> Screening Me '* <br /> Trackln tet - Cy/ n ) <br /> ` 6 _,n. <br /> SPOILS <br /> Storage Method__5`7 ��Inw, MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y ) <br /> Storage Location_ v.n s bt� Casing type Z YAC <br /> Blank t S fc. Screen LI S' h• <br /> ' • Slot size -07-0 <br /> GROLITING Bags cement <br /> Buckets bentonite <br /> Depth to water_ Bags sand/gravel <br /> Mig Ratios Filter Pack type/size *k- 3 �tov�l w tom/ <br /> ittstalladon Method- =„ Surge Block: - (y/0 <br /> Quantity installed Discussed with geologist. - (y <br /> Type of method <br /> EH 29 29. <br /> N <br /> ri <br />