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MONITORING WELL INSTALLATION REPORT <br /> Date:_( i b <br /> CON�CT7ON <br /> Premise Address: c"A <br /> Total Depth �( 5 t <br /> Well No.: (V_ Screen Length (froth) <br /> Filter Pack (from) <br /> Inspector. ��o� <br /> Bentonite <br /> 03 6 <br /> (from) <br /> Grout (from) <br /> Permit No. �r�S Drilling rig type -- (to) <br /> Augcr O.D.— _ I.D. <br /> Drilling Company: Ing , .. I r ( Completion - Stove pipe/du s.Dtle box <br /> (circle one) <br /> AA IC1Driller._ \�C <br /> Consultant casng <br /> —�Af iheight <br /> '4 <br /> Geologisr <br /> U ABCVE-GRCiJND <br /> SPECIAL PERMIT INFO. CO&PLETICN VAS7Y-30X <br /> -- Cra:ndSWxyN <br /> Distance to server line <br /> Domestic well on site - n ) grout <br /> yes, location an [stance - <br /> tt. tt. <br /> SA= _ 4; <br /> _ o <br /> r <br /> _ C <br /> 110r� <br /> Holding Temperature o sac�cn '- <br /> Method — <br /> Screenin, thod = _ ¢avdyack <br /> Trackin hcet _ (y/ n ) <br /> SPOILS _fi. — <br /> tt. <br /> Storage Method <br /> COtitaminaEiO,n Noted - (y/n MATERI <br /> ALS/DEVE[OPMENT <br /> Storage Location <br /> r" Casing type <br /> GROU-nNG Blank 0 fr. Screen <br /> �— Slot size O Z'0 —eft• <br /> Bags cement ti Imo$ <br /> Depth to water n/Co Buckets bentonite <br /> Mix Ratios Bags sand/ <br /> Installation Method 5 sand/gravel v 2 yz( <br /> Filter Pack type/size t� <br /> Qua3 nA ntity Installed – Surge Block ,( ki <br /> EH 29 29 e5 <br /> Discussed withge geologist: - ( / n <br /> Type of method y ) <br /> i <br />