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MONITORING WELL INSTALLATION REPORT <br /> Date: `r-3O`�y <br /> CONSTRUCTION <br /> Premise Address: (C77 7 l-k'w�/twp /� Total Depth Z <br /> Well No.: <br /> i9LA--V _Z 3 Screen Length (from)' z e 6 (to) 2 J6- <br /> Filter Pack (from)_ z r,-/ (to) z <br /> Inspector: Bentonite' (from) e i r (to) Z/ Y <br /> Grout (from) (to) i- rt <br /> Drilling rig type_ ivy rc�r:o� y <br /> Permit No. Auger O.D. -7 %S� PD----- <br /> Completion- ove i christie box (circle one) <br /> Drilling Company: "��on�,A/zG �2�1[c/v6 <br /> Driller: &I r2l5 ,vn44,V <br /> casing <br /> Consultant �RCheight <br /> Geologist <br /> ' <br /> Geologist 1'(A OA/ riAvLvn-V -_ <br /> ABOVE-GROUND <br /> co wFLETIO N CNA ZTY4�cX <br /> SPECIAL PERMIT INFO. COMPLETION <br /> Grund Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) 2 N <br /> If yes, location and distance <br /> - <br /> . ft. <br /> SAMPLING — o <br /> Ila <br /> Lac9an = <br /> Holding Temperature = <br /> Method = t Pack <br /> Screening Method = <br /> Tracking Sheet - (y/n) _ <br /> 2 ft <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) - <br /> Storage Location Casing type S(H- `M PvC <br /> Blank Z(6 ft. Screen Z ft. <br /> Slot size o z-o <br /> GROUTING Bags cement <br /> Buckets bentonite Z <br /> Depth to water Bags sand/gravel_ /Z %Z <br /> Mix Ratios Filter Pack type/size_ ±C 3 <br /> Installation Method <br /> Quantity Installed Discussed with geologist: - (y/n ) <br /> EH 29 29 Type of method <br />