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MONITORING WEI L INSTALLATION REPORT <br /> Date: �( f <br /> Premise Addresr ( ca <br /> . � CONSTRUCTION <br /> t v . <br /> Well No.: �, � Total Depth <br /> Screen Length (from) 9 0 <br /> Inspector. wenn r Filter Pack (fr (to) <br /> om)_ g �(to) <br /> h Bentonire �— - _ <br /> Grout (from) S —(to) R&cs <br /> Permit No. r) (from)- (to)— <br /> Drilling rig type <br /> Auger O.D. <br /> Drilling Company; ---�_ LD. <br /> Completion - Stove pipe/chri tfebox (c— ircl�— <br /> Driller. <br /> o <br /> Consultant casing <br /> 4n height <br /> Geologist e <br /> � t'j �C X�v1MC � <br /> _ AECVE-GRCl1ND T <br /> SPECIAL PERMIT INFO, COAPL`TION CHAMY•dox ' <br /> Cvwnd Sufacy �Cts <br /> Distance to sewer line <br /> Domestic well on si _ (y/n) <br /> If yes, location distance - prat <br /> „' R. ft. <br /> SA�yG <br /> Holding Temperature �IoCad — <br /> Method sac9cn $ <br /> Screening <br /> Trackin — Qavdyadt <br /> ce[ (Y/n) _ <br /> SPOILS <br /> tl. <br /> Storage -Methody�l I o <br /> Contamination Noted ( <br /> MATERI <br /> Storage Location y ALS/DEVE[OPMENT <br /> o� ti n <br /> �— Casing type��(`� <br /> GR Blankg <br /> Slot shze , Z-fr Screen <br /> Depth to water Bags cement�� zes g <br /> Mix Ratios_ S Z Buckets bentonite_J o <br /> InstallationMBags sand/gravel /_ <br /> Filter Pack type Quantity Installed <br /> c/s,<c_�S�a�n <br /> �/ �s �+w�.�. Surge Block: - (y <br /> EH 29 29 Discussed with geologist: - (y y <br /> Type of method l% <br />