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MONITORING WELL INSTALLATION REPORT <br /> Date:_ I z (n S CONSTRUCTLON <br /> Premise Address: a4e.91 WASE &.w Total Depth_ 30 <br /> Screen Length (from) I v (to)_ z a <br /> Well No.: (Z W-(o 2 W- Filter Pack (from) :�,t (to) 3Q <br /> Bentonite (from) !L5--c' (to)_ -f-S <br /> Inspector. _ Q in.n�m�, Grout (from) i (to) <br /> Drilling rig type <br /> Permit No. AugerO.D. I.D. <br /> / Completion - Stove pipe/cluisde box (circle one) <br /> Drilling Company �ra�P�lil C <br /> Drilleri_ Aw � '9 casing <br /> height <br /> Consultant_ <br /> Geologist <br /> ` I AP.OVE-GRCUND <br /> COWP L..E-DON Ch---1Z IY-30X <br /> SPECIAL.PERMIT INFO. COWLEncN <br /> GcundSu-fact <br /> Distance to server line <br /> Domestic well on si>- (y/nIf yes, location and e ft. <br /> LV <br /> SAMPLING <br /> 0 <br /> socicn — <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> SPOILS p <br /> Storage Method _MATERTALS/DEVELOPMENT <br /> Contamination Noted - (Qi ' n ) />r- . Qcf rn5 <br /> Storage Location_ Casing type 2 /Yu( •`Po <br /> Blank ft. Screen fr• <br /> Slot size .0 zo <br /> GROUTING Bags cement <br /> Buckets bentonite C&NA10'I <br /> Depth to water 1 L -t s, '� Bags sand/gravel <br /> Mik Ratios Filter Pack type/size A�S sxkkc Sw,wA <br /> 4ristallation Method roatnnr Surge Block: - (y/n ) <br /> Quantity installed Discussed vrith geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br /> 01 <br />