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MONITORING- WELL INSTALLATION REPORT <br /> Dace: / . 0 CONSTRUCTION / <br /> Premise Address: /CJ / / v` /��✓ / Total Depth 2 <br /> t eyj Screen Length (from) ! v (to) ZS <br /> Well No.: W t� �o ) To ` ' Filter Pack (from) (to) 25 � <br /> Bentonite (From) _(to) 9 <br /> Inspector. Grout (from) <br /> Drilling rig type <br /> Permit No. Auger O.D. 1D t/ I.D._ ee ' <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: l!G <br /> Driller: �ea-t Fmj, <br /> casing <br /> height <br /> Consultant ( lCl <br /> Geologisty ' y' ` ic"`fv— ABOVE-GRCUND <br /> CaWL_ETION Ch8:SiY-30X <br /> CCkd?L_'" nCN <br /> SPECIAL PERMIT INFO. G=rd 5�'c' <br /> Distance to sewer line drat <br /> Domestic well on site - ( y / n ) II <br /> If yes, location and distance - ft <br /> h. <br /> - = c <br /> SAMPLING doesi <br /> sacicn = <br /> Holding Temperature — Lnvd Paas <br /> Method = <br /> Screening Method <br /> Tracking Sheet - ( y / n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) <br /> Storage Location Casing type <br /> Blank /i/ fc. Screen,./. R• <br /> Slot size /;�2 D <br /> GROLMNG Bags cement_ 4b409 4'Y 2e7 gav <br /> Buckets bentonite dw <br /> Depth to water Bags sand/gravel <br /> Wk Rados Filter Pack type/size <br /> dpstallation Method Surge Block: - ( y / n ) <br /> Quantity installed Discussed vrith geologist: - ( y / n ) <br /> Type of nethod — <br /> EH 29 29 <br />