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MONITORING WELL INSTALLATION REPORT <br /> Date:__ !., I zt �� y q CONSTRUCTION <br /> Premise Address: Total" 'l-�r__ Total Depth <br /> G 54W Screen Len <br /> Well No.: Wt t. 1--Cu � .� ,t4i Length (from)_ s o� (to) an <br /> -- e�n,,a-.sc.L,w•fv„/Filter Pack (from) i $' (to) _ <br /> Inspector.{LQ kU J I �" "�"7 `t°t" '{" tvkQ Bentonite (from)_ <br /> Grout (from)_ F (to)_ 4 5� <br /> Permit No. Drilling rig type <br /> Auger O.D. ipe, <br /> Irisbo (circle-one)]ling Company Completion Stove <br /> ;i <br /> Driller:_ � --- T7 <br /> _ _ casing <br /> Consultant , height <br /> Geologist (°iln <br /> ABCVE-GRCOND <br /> 001. LFrJON �STY30X <br /> SPECIAL PERMIT INFO. COMPL_`TICN <br /> Ground Suiacy <br /> Distance to sewer line <br /> Domestic well on s' gran <br /> If es local Y/ n ) <br /> yes, y and distance - <br /> SAMPLING = <br /> doted = c <br /> Holding Temperature_ CA. , c secicn - B <br /> Method' <br /> Screening Method <br /> Tracking Sheet PIII _ <br /> SPOILS ` _ {t <br /> Storage Method r--�^��Ioz^a, <br /> Contamination Noted - ('y/n ) MATERIALS/DEVE[OPMENT <br /> Storage Location <br /> Casing type 2 <br /> Blank ft. Screen___LCL__ft <br /> GROUTING Slot size <br /> Bags cement <br /> Depth to water w631 Buckets bentonite <br /> Mix Rados rw - / S-6- F a Bags sand/gravel N z <br /> Installation Method T Filter Pack type/size <br /> Quantity Installed Surge Block: - (y/ tt ) <br /> Discussed with geologist•. - ( y/ n) <br /> EH 29 29 Type of method <br /> /� A%. <br />