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MONITORING WELL INS'TM-LAMON REPORT <br /> CONSTRUCTION <br /> Date: ' <br /> ,t,� Total Depth (to) <br /> Premise Address: 7ifZ Screen Length (from) <br /> Wel! No.: Filter Pack (from) {to} <br /> Bentonite (from) (to) <br /> Grout (from) (to) <br /> Inspector: Drilling rig type <br /> Auger,O.D. LD. <br /> Permit No. Completion - Sto,e pipe/christie box (circle one) <br /> Drilling Company: U✓ <br /> casing <br /> Pkv' <br /> he; <br /> Consultant=� A _ .�► <br /> Geologist �� A?,pYE-GRCUND CIsR:ST`d-aax <br /> Ground sLztaa. <br /> SPECIAL PE _INFO, <br /> q rj2--Z c f grout <br /> Distance to sewer line It. <br /> Domestic well on site - {y/n) . <br /> If yes, location and distance - <br /> y C <br /> b <br /> SAMPLING socicn <br /> Holdin emperatur.- <br /> Metho — <br /> Scree ino Method <br /> Trac g Shcet (y/n) j = n, <br /> SPOILS <br /> MATER[ALSIUEVELOPMENT <br /> Storage ethod <br /> Cont [nation Noted- (y/n) Casing type <br /> Sto a Location Bl� ft. Screen <br /> Slot size <br /> Bags cement <br /> GROU'T'ING Buckets bcnto to <br /> T� Z = !j l� <br /> Bagssand/ el <br /> Depth to water Filter Pack c/size <br /> Mix Ratios Surge Block: (y/ n} <br /> -Installation Me od Discussed v th geologist: - (y/n) <br /> Quantity Inst ed Type of rule -to' <br /> EH 29 29 <br />