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MONITORING WEIL INSTALLATION REPORT <br /> Date: 2 `�I 0 CONSTRUCTION <br /> n n) . t Fz ,. Total Depth <br /> Premise Address <br /> g� <br /> Sween Length (from) (to) <br /> YA la) - l v 2 Filter Pack (from) (to) <br /> Well No.: <br /> Bentonite (from) (to) <br /> Grout (from) Cto) <br /> Inspector. 11' Drilling ng type <br /> Permit No. $h I q Auger O.D. 1 <br /> 1_ Completion-Stove PiP Christie box (circle one) <br /> Drilling Company: ICJOC�M1An� <br /> casing <br /> Driller. o —4F height <br /> r <br /> Consultant .S -h ��-� / o <br /> �\ W <br /> IA l�' OIAn. <br /> Geolog-st - Jl9CVE-..aCUND <br /> CC&PI=f ION C--MP_—,1CN <br /> Gr�ut+d Sutacr . <br /> SPECIAL pzR-, L', INFO. <br /> cut <br /> Distance to sewer line 1c (,O <br /> Domestic well on site - (y/ n ) _y t <br /> If yes, location and dismn <br /> c <br /> 0 <br /> SAN?IING a1vm. <br /> - = <br /> sewn - <br /> Holding Tempe e m I rA _ 9M°i1 <br /> Pack <br /> b , <br /> Method ilno:�i �I4�— M _ <br /> Screening Merhod <br /> Tracking Sheet - C y/ n ) <br /> eK S = ti <br /> SPOILS <br /> Storage Method SS �^^ —' MATERLAI.S/DEVELOPME-NI' <br /> Contamination Noted - C y k-;O Casing We Z �IAV r <br /> Storage Locations^< < Blank 6 5- ft Screen_�_fr <br /> Slot siu •07-O <br /> Bags cement 7-0 <br /> GROU71NG Buckets bentonite ( lily r <br /> Bags sand/gravel .-� V Ga T <br /> Depth to waterFIlte Pack type/size <br /> Mia Ratios 0-4 z 6 S Surge Block: - (yam a) <br /> Installation MethodDiscussed with geologist - (y <br /> Quanriry Installed �/�11" ' <br /> Type of method <br /> EH 29 29 <br />