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MONITORING WELL INSTALLATION RFPORT <br /> Date: 4 1 tl 1�� CONSTRUCTION <br /> Premise Address: 0KNnUU ucnti Total Depth bO <br /> Screen Length (from).—(to) (�n <br /> Well No.: PA k.I-- \ Filter Pack (from) 18 (to) �'o <br /> Bentonite (from) i <' (to) _ <br /> Inspector. ( t1�Ac � Grout (from) I (to) I < <br /> Dulling rig type <br /> Permit No. Auger O.D. I n I-D. — _ <br /> Completion- Stove pipe/ 'e� (circle one) <br /> Drilling Company. �a� <br /> Duller. ng <br /> casi <br /> height <br /> Consultant �r <br /> Geologist <br /> A8r'V=-+iAL'UN0 CtA3SY-3CX <br /> =&F Er4N <br /> SPECIAL PERMIT INFO. rrourd mace <br /> i <br /> Ind <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) ♦ 1S fL <br /> If yes, location and distance - <br /> .L <br /> c <br /> 0 <br /> SAMPLING slaoad <br /> sn^an <br /> Holding Temperature -- = 9mvi pack <br /> Method <br /> Screening Meth L-5 <br /> Tracking Sheer - n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contaminationy/ n ) <br /> Storage Location Casing type k P\/ Q- <br /> Blank 20 fr. Screen L1h fn <br /> Slot size O ZO <br /> GROUTING Bags cement ( - 9 H I to G • ��. <br /> Buckets bentonite <br /> Depth to ware- 5 Bags sand/gravel 9 - 1yo <br /> Mix Ratios Filter Pack typesize. --rY 3 R me <br /> Installation erho Surge Block: - � n) <br /> M <br /> Quantity Installed n v Discussed with geologist. - (:�j a) <br /> Type of method <br /> EH 29 29 <br />