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MONITORING WELL INSTALLATION REPORT <br /> —�YPrrir <br /> Date: <br /> - s" CONSTRUCTION <br /> Premise Address: 4 Total Depth 3 3 <br /> Screen Length (from) 30 (to) 93 i <br /> Well No.: A �- l Filter Pack (from)_ 3� ` (to) 2q r <br /> Bentonite (from) 2 ' (to) 01 <br /> Inspector: V�` 1C Dec r�rz•u., '- �c1aS �?e Grout (from) 7` (to) r <br /> es -Frr G�ro1j 'e sPcc.� Drilling rig type - 3 <br /> d <br /> Permit No. 4-3�' 2 L �,- Auger O.D. 8 ;n�.� I.D. i I <br /> p Completion - Stove pipe/clu-istie box (circle one) <br /> Drilling Company: _&Y— <br /> Driller: obe- /�Ve� yv(�5 1oDP.Y "br casing <br /> Hoo p-e 61 + he=ght <br /> est;s-i-�✓t#s - - Sean RQJ�vW �in,d .61",C- <br /> Consultant <br /> 7F <br /> SGeologist O La n e n n APAYE-GRCIJND <br /> R!, <br /> COWPLET16N cowETICN <br /> SPECIAL PERMITINFO. S�st3ca <br /> prcxrt <br /> Distance to sewer line Ur29.4d <br /> Domestic well onsite - (y/ n7 _ �s ,3 7 ft. <br /> If yes, location and distance - N 6DfPYI-- 2 ft• <br /> v � M <br /> O <br /> SAMPLING <br /> �y S•r socicn <br /> U � <br /> Holding Temperature <br /> Method <br /> Screenin;Method I y <br /> Tracking Sheet y n) <br /> 33 h. -- 3 S tt. <br /> SPOILS <br /> Storage Method - MAT ERIALS/DEVELOPMENT <br /> Contamination Noted - CY0111 ) Casing typ <br /> Storage Location r�,e'1 �� ��° BlankU__fr. Screen 3 n' <br /> Slot size <br /> Po-e+I-S.y — cement - b <br /> GRO_URNG 7S�1ji. cts bentonite , <br /> 'b' Bags sand/gravel <br /> Depth to water 2 �S b la ayypFdter Pack type/ i e ?i <br /> Mix Ratios <br /> �PIPSurge IItock: - <br /> d�stallation M odDiscussed vrith geologist: n) <br /> Quantity Installed Type of rnctliod Sv r d b - <br /> EH 29 29- . <br />