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MONITORING WELL INSTALLATION REPORT <br /> Date:_ f zy C� CONSTRUCI'10 <br /> Premise Address:_ G (7 A) Total Depth to I <br /> �T Screen Length (from) 95- CS(to) I U <br /> Well No.:_ > �— Filter Pack (from) 3 (to)_ I ba <br /> Inspector. __ I� Bentonite (from) SCJ (to) <br /> Grout (from) -0 - (to) <br /> Drilling rig type AT <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: ( Completion - Stove pipe/cluistie box (cir <br /> Driller. <br /> casing <br /> height <br /> Consultant <br /> CE:roIlk <br /> � <br /> Geologist_S ,t C' T <br /> AECVE-GACUND T <br /> COWLLETICN C70* Y-aoX <br /> SPECIAL PERMIT INFO. COW31—EMCN <br /> _ Ground S(Sfaot <br /> Distance to sewer1ine' <br /> Domestic welly -site (y/ n ) Orwt -'4�4 <br /> If yes, location and distance - fI. <br /> a <br /> SAMPLING - <br /> _— o <br /> dorod — c <br /> Holding Temperature +ocicn = g <br /> Method <br /> Screening Method I(� <br /> Tracking Shcet �Ly/ n ) <br /> SPOILS <br /> Storage Method <br /> Contamination Noted • (y n MATER!ALS/DEVE[OPMENT <br /> Storage Location_ L s <br /> Casing type <br /> -- -2Blank <br /> J S ft. Screen------zi- _h. <br /> GREG Slor size_• 0;' C) <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> Mix Ratios �, ,. -S Bags sand/gravel n - <br /> Installation Method , t f Filter Pack type/size <br /> Quantity lnsralled Surge IIlock: • ht ) <br /> Discussed with geologist: • ( y <br /> EH 29 29 Type of method <br /> r 1� <br />