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MONITORING WELL INSTALLATION REPORT <br /> C3 <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth O <br /> n Q f• f' Screen Length (from) dto) E <br /> Well No.: !+^� ` °/ /f�v`�` • �/`� Filler Pack (from) D ,-(to) <br /> 2 trno t e (from) (to)7' <br /> Inspector. rout (from (to) s <br /> �J D ' ling rig type <br /> Permit No. / A O.D. y LD. y <br /> comp ledo ove pipe/christie bcs (circle one) <br /> Drilling Company: S/xf <br /> Driller: casin <br /> height <br /> Consultant�61 "t tr i - � V + <br /> Geologist o VE-GFICUND <br /> LEMN C- A SK30X <br /> CA',U'L-'TICN <br /> SPECIAL PERMIT INFO. Card Suian �-Z —• <br /> Distance to sewer line - prcS <br /> Domestic well onsite - ( Y/ n ) ! lt. <br /> if yes, location and distance - g_ <br /> — o <br /> SAMPLING slorad <br /> socicn - — <br /> Holding Temperature Lr+ ; <br /> Metho <br /> h.d = <br /> Screening Mechod <br /> Tracking Sheet, - (y/ n ) <br /> I <br /> SPOILS <br /> Storage Method ) MATEWAWDEVELOPMEN(T <br /> Contamination Noted - (y/ n) Casing type PC J L <br /> Storage Location �glp fc Screener_ h' <br /> Slot size c .L <br /> GROUTING Bags cement <br /> Buckets bentonite Sa <br /> Depth to water Bags sand/gravel 1 c t <br /> P Filter Pack type/siz <br /> Mirz Ratios Surge Block: - (y n ) <br /> 4ris[allation Method Discussed vvith geologist: - 0/ n) <br /> Quantity installed Type of ncthod <br /> EH 29 29 <br />