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MONITORING WELL INSTALLATION RFpORT <br /> Date: p 03 <br /> WONION V e I <br /> Premise Address: U g So tnn 1 f - <br /> -- — Total Depth_ [� I <br /> Well No.: �e) Screen Length (from) <br /> Filter Pack (from) cry ' (to)_��n <br /> Inspector. �.n �� Bentonite (from)--q -.-5, (to) TT— <br /> Grout (from) $- (to) _ <br /> Permit No. .3 �' Drilling rig type (�-5 <br /> �^_----- Auger O.D. LD. <br /> --------- <br /> Drilling Company �M O^ Completion - Stove pipe/chrispe bo—� <br /> (circle one) <br /> Driller._ SLI 12 <br /> Y_ casing <br /> ConsultantiL)HE height <br /> A-*C VE-GFIC0ND <br /> SPECIAL PERMIT INFO. 00?A'LFTCN G�Au7Y3px <br /> COh4PL_RPON <br /> Groc!t�Suiacr <br /> Distance to :ewer line <br /> Domestic well on site - (y/n-) = grout <br /> If yes, location and distance= <br /> f t. <br /> o <br /> SAS t., <br /> — c <br /> Holding Temperature m r� dslornd <br /> soen <br /> Method "��c r� -, _ <br /> Scree z-Qoa _ _ <br /> Wino Method _ p-svvlyack <br /> Track ng Sheet - (y/ n ) <br /> SPOILS —ft. <br /> Storage Method -s <br /> Contamination Noted • y n h MATERIALS/DEVE[OpMENT <br /> Storage Location <br /> mss <br /> Casing type <br /> GR�_G Sloat siz fr. Screen <br /> Bags cement <br /> Depth to water /V S Buckets bentonite <br /> Mix Ratios— Bags sand/gravel, <br /> Installation Method Filter Pack type/size <br /> Quantity Installed Surge Block: - (y/ tt ) <br /> Q Discussed with geologist: - ( y <br /> Eli 29 29 �- �� G 6 se^u" Type Of medrod <br />