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' ( V <br /> MONITORING WELL INSTALLATION REPORT <br /> Date:_ II Lo <br /> CONSTRUCTION <br /> Premiss a Address: 2 c7� S t , t nn <br />' Total Depth <br /> Well No.: VV1 W Screen Length (from) <br /> I Filter Pack ) (to)�?�— <br /> (from) y (to)_ _ <br /> Inspector. 11. Bentonite (from) r 2 (to) . t� <br /> Grout (from) �— <br /> Permit No. Drilling rig type (to)�-- <br /> �7 Auger OZ.___ I.D. <br /> Drilling Company: Tlrn �c,' Completion - Stove pipe/cluistie box (circle o <br /> Driller. S�G. <br /> casing <br /> Consultant �px height <br /> Geologist� oX <br /> AP,OVEGACUND, <br /> SPECIAL PERMIT INFO. COMPLETION C4-SZTY-a0X <br /> Cxnt:nd SuiacrCOMPLEnCN <br /> - <br /> Distance to sewer line <br /> Domestic well on site - Cy/n )- <br /> 'yes, - Ort <br /> IL location and distance _ <br /> f t. <br /> gr <br /> SAMPUN G t• _ <br /> HoldingP Bored <br /> Temperature n,_ A • ixicn = B <br /> Method <br /> Screenin, .nemoa P6D = 167h. <br /> Tracking SheetnSPOILS- .ft. _ _ <br /> Storage Method <br /> Contamination Ivorea . n , MATERIALS/DEVE�NT <br /> Storage Location �n1.7b <br /> Casing type Z ev <br /> Blank GO fr Screen <br /> _--?—05 <br /> �.G slot size _fT- <br /> 6Z-e7 <br /> Bags cement <br /> Depth to water ,v S Buckets bentonite <br /> Mix Ratios Bags sand/gravel � <br /> Installation ethe Filter Pack type/size <br /> Quantity Installed Surge Block: - (y it� <br /> Discussed with geoiogist: - (y <br /> EH 29 29 Type of method <br /> _ v <br />