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MONITORING WELL INSTALLATION REPORT <br /> Date: �, I g I OD CONSTRUCTION <br /> Premise Address:__ 1 (nlno „A <br /> rn Tota! Depth a.5 <br /> Well No.: <br /> � '^ �/ Screen Length (from) (to)?. <br /> 1M ln� - i L_ Filter Pack (from),- <br /> from) t to 2-5 <br /> t <br /> Bentonite (from) L t (to)T <br /> inspector. 1� tnnnCn V, Grout (from) -91 (to) <br /> Permit No. 0 0 A,)-O Z I Drilling rig type <br /> Auger O.D._( ” I.D. <br /> Drilling Company: M <br /> I e�j Completion - Stove pipe/christie box (circle one) <br /> Driller: rf„tA IM&�� � casing <br /> he; <br /> Consultant ('�O.rn�t �o� a� <br /> Geologist ,S P <br /> ABOVE-GACOND <br /> CONPLFTICN CXRZTY-30X <br /> SPECIAL PERMIT INFO. CG�t PLTICN <br /> 6rourd S�rlact <br /> Distance rosewer,ia proof <br /> Domestic n ite - (y/ n ) <br /> If yes, ton and distance - I ' tt. <br /> � ft. <br /> ~ O <br /> 72 <br /> SAMPLING — o <br /> slonod c <br /> sacicn = <br /> Holding Temperature <br /> MethodL"(,� 0 _ = pravd pads <br /> Screening Method = <br /> __ <br /> Sheet - n = <br /> Tracking _ — <br /> tt. _ a S ft. <br /> SPOILS <br /> Storage Method -1, , Cd; ,..-,,,. - MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y( n ) <br /> Storage Location 'v <br /> Casing type nZ <br /> Blank_ a'W eft Screen AD--ft. <br /> Slot size . 0-2-0 <br /> GROUTING Bags cement <br /> Buckets bentonite x�i <br /> Depth to water Bags sand/gravel_ � <br /> Mix Ratios Filter Pack type/size / <br /> Installation Method Surge Block: - (y/ n <br /> Quantity installed Discussed with geologist: - ( y/ n�) <br /> EH 29 29 Type of method <br /> P <br />