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MONITORING WELL INSTALLATION REPORT <br /> Date:_ 2 O f CONSTRUCTION <br /> e <br /> Premise Address: <br /> Total Depth t-(c <br /> Well No.: <br /> + Screen Length (from)_ 2v` (to)_ y p <br /> P14("(2, 3 Filter Pack (from)_ L td (to)p <br /> \ � Bentonite (from) <br /> Inspecto <br /> r- _ f u Ani/pl Grout (from) 4;- — <br /> (to)---- �_ <br /> Permit No. n c, z F�q I Z Drilling rig type <br /> Auger O.D. <br /> Drilling Company: Completion - Stove pipe/ iris tie bo (circle one) <br /> Driller: <br /> height <br /> casing <br /> Consultant ��-Yc- -{.��; � S,A ,p ,�, <br /> —t,WT <br /> Geologist_ <br /> A.°CVE-GAc,uNO <br /> CO hP LETfC N C4 -aOX <br /> SPECIAL PERMIT INFO. COMPL-17CN <br /> Ground SLeacs <br /> Distance to sever line <br /> Domestic well on site - ( y/ <br /> If yes, location and dist e - <br /> ' f t. <br /> ft. �- <br /> tip. 0 <br /> M <br /> SAMPLING c <br /> storm — c <br /> Holding Temperature +Qc cn $ <br /> Method = <br /> Screening Metho _ <br /> gnvw F� <br /> Tracking Shce,je _ ( y/ n ) <br /> SPOILS <br /> Storage Method 1- y <br /> An <br /> Contamination Noted _ MATERIALS/DEVFI OPMENT <br /> Storage Location � ) r <br /> Casing type-- 2� IP\/ <br /> Blank— p ft. Screen_ <br /> GROUTING Slot size _ b <br /> Bags cement <br /> Depth to water S ` Buckets bentonite <br /> Mix Ratios Bags sand/gravel-- <br /> Installation Method Filter Pack type/size -J+ <br /> Quantity Installed Surge Block: - ( y/ n ) <br /> Discussed with geologist: - ( y/o <br /> EH 29 29 Type of mctliod <br />