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MONITORING WELL INSTAL LATION REPORT <br /> Date: 1CONSTRUCTION <br /> Premise Address: (a 100 h1• P" Y CI Total Depth �S <br /> Screen Length (from) S— IT <br /> Well No.: Nn l.\j Filter Pack (from) (to) <br /> Bentonite (from) d. (to) <br /> Insoecror. INAA�r^. , Grout (from) (to) 6L [ <br /> Drilling ng type4� <br /> Permit No. S 5 S Auger 0-D. Ss', I.D. <br /> I' ( Completion-Stove pipe/christie box (circle one) <br /> Drilling Compal: lJnneY.Wn�__/I <br /> Driller. kzj4 casing <br /> height. <br /> Consultanr r <br /> Geologist LSC1/' <br /> ABCVE.;ACUND C7-ffiiS Y-ScX <br /> CCbPf E'AN C.^MP'CCN <br /> SPECIAL PER-VETT INFO. Gr.=nd Sul"' <br /> Distance to sewe±line R <br /> Domestic well on site - ( �Z <br /> If yes, location and ce - L y <br /> _ c <br /> e <br /> SAMPLING abnad = <br /> sec=n - — <br /> Holding Temperature !nn i rA = ¢a„a'ack <br /> Method <br /> Screening Method <br /> �tlyPI 0 <br /> Tracking Sheet - V n) <br /> rsSR — �S tL <br /> SPOILS <br /> Storage Method $`7/ MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( n <br /> Storage Locarion 6\n " Casing type 2 PVZ <br /> Blank----Lft- Screen--AC2—fr- <br /> Slot size o O <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Denrh to water N 1 Bags sand/gravel <br /> Mia Ratios Filter Pack type/size -lk- <br /> Installation Method Surge Block: -0�n) <br /> Quantity Installed Discussed with`g/eologisc -ffY n ) <br /> Type of method <br /> EH 29 29 <br />