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MONITORING WELL INS'T'ALLATION REPORT <br /> Date:_ i Z60:, l CONSTRUCTION <br /> r <br /> Premise Address: ��� ��,;(r�,,¢�. Total Depth_ 3S� <br /> Screen Length (from) _(to). <br /> Well No.: ��M 1� `SIS Filter Pack (from) a —(co)-.S <br /> Bentonite (from)_ +�� ` (to)� <br /> Inspector:_ D.,,v.r-o+a.- Grout (from) f6 (to) Z-e <br /> Drilling rig type <br /> Permit No. C( `{ 1 Auger O.D. I.D. <br /> Drilling Company;_ <br /> Completion - Stove pipe/clu-istie box (circle one) <br /> Tv�- l�inn.t..�cc� <br /> Driller: YV��(� 2aJe e.,� 1z casing <br /> Fm <br /> he=ght <br /> Consultant_ (-�g, „r 5 <br /> GeologistCayQ y,. \ <br /> • ABO E-GRCUND c,�-A:STl'30X <br /> COl,-s'LETO N C10&{r0L,T1CN <br /> SPECIAL PERMIT INFO. Su{ <br /> Distance to sewer line Urc(A <br /> Domestic well on <br /> If yes, location tance - <br /> V' O <br /> SAMPLING <br /> socicn - � <br /> Holding Temperature <br /> Method -- <br /> Screening Method "= — <br /> Tracking Sheet - (y/ n ) �•' <br /> SPOILS <br /> Storage Method_ I v1 MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type 7 PV <br /> Blank -bw5-ft- Screen (O �• <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite I .c SwrJA-Y Y, <br /> Depth to water N "L;L Bags sand/gravel_ <br /> Mix Rados 191-411 "21J9J,,,,& S!M�Zp Filter Pack type/size 2,6" <br /> � <br /> installadon Method U Surge Block: - ( y/d) <br /> Qua nticy Ins calledDiscussed with geologist: - (y/Q) <br /> Type of method <br /> EH 29 29. . <br />