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MONITORING WELL INSTALLATION REPORT <br /> Date:_ ( (7 f7 <br /> CONSTRUCTION <br /> Premise Address: Q yp Tom pp � <br /> Total Depth a 3 <br /> Well No.: mtk) 1 Screen Length (from)_ 101 (to) _ <br /> Q Filter Pack <br /> (from) �O (to) _ <br /> Inspector _ bd Bentonite (from)_ ( � (to) Z.Z,L <br /> _ n�tin,�,� . Grout <br /> (from) (to)�— <br /> Permit No. .Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company; I�VIn , / / Completion - Stove pipe/cluistie boxbox (circle <br /> Driller. VlAt�nti <br /> U �_ casing <br /> Consultant_�� f height <br /> � v v <br /> Geologisr_� ��� , ` <br /> f ARC VE-GF3MND <br /> SPECIAL PERMIT INFO. CCV'LFrCN CF•A;S7y.3Ox <br /> r-OMPL_`ncN <br /> Gra:r�Sutacs <br /> Distance to sewer line <br /> Domestic well on site - (y/ Ort <br /> If yes, location and dicta g <br /> ft. <br /> •--�_ft. ft. <br /> S AMPU NG = <br /> r <br /> slora,� — c <br /> Holding Temperature soden = g <br /> Method — <br /> Screening lute zravdPrst <br /> Tracking S et - (y/n ) 53: <br /> SPOILS <br /> Storage Method �� (� <br /> ContaminationNoted • (y n M—ATERIUS/DEVE[OPMEITi <br /> Storage Location <br /> Casing type— 2– <br /> Blank <br /> Blank 2_Z fL Screen___SIL_fr_ <br /> GR_OVTI\G Slot size 1522-0 <br /> Bags cement <br /> Depth to water ti Buckets bentonite <br /> Mix Ratios Bags sand/gmvcl <br /> InstalQuantity11Method Filter Pack type/size <br /> Quantity lnsrallcd Surge Block: - (y/®) <br /> Discussed with geologist: . ( y <br /> EH 29 29 Type of method <br /> '-1, <br />