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MONITORING WELL INSTALLATION REDORT s <br /> d � C <br /> • o: a o <br /> M o <br /> CONS`, <br /> Date: <br /> Total Depth (to) <br /> Premise Address• !td Screen Length (from)_—_-- <br /> (co) <br /> Filter Pack (from)-- •--([o) <br /> Well No. �N l� Bentonite Grout (from)- <br /> r. r' `F D�lmg ng type <br /> Inspecto <br /> A .D. <br /> Permit No. <br /> Completion - Sto Pipe/christie box (circle one) <br /> an ^ r <br /> Com <br /> Drilling P Y casing <br /> height <br /> Driller: '9 ` <br /> Consultant �k <br /> ,/ �_�_�—. Av_gVE-GFICUND ChR'SfY X <br /> Geologist I WI pDNr�t�iyON t(js J CCMF,--- 1CN <br /> t rC � <br /> SPECIAL PERMIT INFO. prat <br /> Distance to sewer line tt. <br /> Domestic well On site C Y '�-- <br /> if yes, location and distance - � — <br /> a" — a <br /> - e <br /> — c <br /> socicn <br /> SAMPLING f aid pax <br /> Holding Temperature 1�g5 �nw> 5�1OT <br /> Method Igp,g zli2 s Wo = <br /> ([fL 1 _ . <br /> Screening Method ft. <br /> Tracking Shcet - (Y <br /> SPOILS n TERIgS/DEVELoPMENT <br /> Storage Method <br /> Contamination Noted - (Y/ n) Casing type Screen— � <br /> Storage Location Blanker—fr <br /> Slot size 0,02.0 <br /> Bags cement IIJ <br /> GROLTIING Buckets bentonite <br /> Bags sand/gravcl <br /> Filter Pack type/stze <br /> Depth to water gorge Block: - (Y/n) <br /> Mix Ratios Discussed vrith geologist: <br /> Quantity - (Y/ n) <br /> tit anti tion Method Type of mctlrod <br /> itutalted . <br /> EH 29 29 <br />