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MONITORING WELL INSTALLATION REPORT <br /> J <br /> Date:_ h 13U O <br /> CONSTRUCTION <br /> Premise Address:- <br /> Total Depth (, <br /> Well No.:_ pin 1 I I i 1 Screen Length (from)_ S (to) <br /> Filter Pack (from)--T—(to) <br /> Inspector-. A.N 0. Bentonite (from)_ I ' (to) 4 <br /> Grout (from) (to)— <br /> Permi[No. Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling company- W Completion - Stove pipe/christiebox (circle <br /> Driller-- A I rezg X <br /> U Y_ casing <br /> Consultant P . I I height <br /> Geologist <br /> APAVEr,ACUND <br /> SPECIAL PERMIT INFO. CObPL``T10N CwG*7Y-aox <br /> cYoond surk, <br /> _mcN <br /> Distance to sewer line <br /> Domestic well on site - .y'/n) grult <br /> If yes, location aid [stance - <br /> f t. <br /> S <br /> SAMPUNG _ <br /> slonnd = c <br /> Holding Temperature socicn = 3 <br /> Method <br /> Screening. od = Crsvayadt <br /> Trac ' Shcet - (y/n ) <br /> SPOILS �fi• �T tt, <br /> Storage Method <br /> Contamination Noted MATERIALS/DEVELOPMENT <br /> Storage Location <br /> Casing typed PV °L <br /> Blank ft. Screen�_� <br /> GROUTI\G Slot sue ow <br /> 1329s cement <br /> Depth to water_ t Buckets bentonite <br /> Mix Ratios f (�y Bags sand/gravel <br /> Installation Me od_ Filter Pack type/size <br /> Quantity Installed^nom Surge Block: - (ytt ) <br /> Discussed with geologist: . (y n <br /> EH 29 29 Type of mcdtod <br />