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MONITORING WELT,INSTALLATION REPORT <br /> Date:._ ( .I t 1 O 1 CONSTRUCTION <br /> Premise Address:. Total Depth Z_C7 1 <br /> Screen Length (from) I C? —(to)�_ <br /> Well No.: _JM iAJ — I �•• ._ _ Filter Pack (from) i (to) <br /> - Bentonite (From} (to)�� <br /> Inspector,�� Lot �, GrouC (From) f'- <br /> _ (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. <br /> Completion - Stove pipe iris tie box ircle one) <br /> Drilling Company; r�1!« �o <br /> Driller'- y. C' casing <br /> .. �FF1I eight <br /> Consultant � o c..(. L,v - <br /> .3; <br /> Geologist c <br /> VF-Gr'IC(JND <br /> CO YP LETIO N C-1 STY-i�X <br /> SPECIAL PERMIT INFO. <br /> C�ur•�Stxfx-a <br /> Distance to sewer line Ora. <br /> Domestic well on site.- (y/ n) <br /> If yes, Iocation and distance ft. <br /> r <br /> SAMPLING <br /> Holding Temperature <br /> Method <br /> Screening Method I _ VIVW' <br /> ack <br /> Tracking Sheet n ) <br /> SPOIIS ft. tt. <br /> Storage Method ¢' ' <br /> Contamination Noted - i } MATERIALS EVEI.OPMENF <br /> Storage Location <br /> Casing type <br /> BIa.nk <br /> GRNG Slot size Zp <br /> Bags cement <br /> Depth to water ry]2. �' r 2uckcts bentonite <br /> Mik Ratios B?-Zs sand/gravel N <br /> stalIatian Method Filter Pack type/size x Z <br /> Quantitylnstalled Surge Block: - (y iZ <br /> Discussed with geo ogisr. - (y ) <br /> EH 29 29. Type Of method <br /> J <br />