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MONITORING WELL INSTALUMON REPORT <br /> 11 <br /> TRUGTf4N • <br /> Date: r-- <br /> Total Depth <br /> Premise Address: Screen Length (from) (co) <br /> '.,Filter Pack. (from] (t ---- <br /> Well No.:* Bentonite (from) (to) <br /> Grout (from) (to) <br /> Inspector. Drilling ng,type <br /> Permit No. • " ` Completion-Stove pipe/du►stie box (cir a one <br /> Drilling Compan): <br /> . ZI <br /> hes�n` <br /> Driller': _ � <br /> ht <br /> FM <br /> Consultant •� <br /> Geologist AYE-GSCUND ct tiRkSTYz30X <br /> OOWLETSON <br /> --G=rid St-3•facs <br /> SPECIAL PF. [it INFO. <br /> Distance to sewer line _ ft. <br /> Domestic well on site,., (y✓n)- ft. <br /> If yes,location and distance - <br /> SAMPLING storad. •%= _ � .. <br /> socicn <br /> Holding Temperature <br /> Method Vdi6n <br /> Screening Method <br /> Tracking Sheet - (y!n) <br /> _..tt. <br /> PSL OILS . • •' - <br /> Storage Method • _ .'',fi � `"- yIA�RIALS/DI;VELOPMENT ' <br /> k P� <br /> Contamination Noted- n) r casing type � �— <br /> Storage LocatioBlank ft. Screen f <br /> _ Slot size <br /> GRO NG ' Bags cement _ <br /> Bud= bentonite <br /> Depth to tvateV442Jf1W8l Bags sand/gravel <br /> mix Rados Filter Pack type/size <br /> .Surge Block: - (y/n) <br /> 4 ast allation Method st: - <br /> Quantity installedDiscussed with Seowtdgi (y/.n <br /> Type of tnediod <br /> EH 29 29• - <br />