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MONITORING WELL INSTALLATION REPORT <br /> Date:, 1 - / 7 /fk/ <br /> CONS�IN <br /> Premise Address: <br /> Total Depth T5 fy <br /> Well No.:. /A-W-/ Screen Length (from) q <br /> Filter Pack (from) 7— 0 (to)— <br /> Bentonite <br /> Inspector: -- _(to) <br /> (from) (og <br /> Grout (from)— —(to) Ze <br /> Permit No. Drill' ri FK— <br /> $ $type_ K 8% <br /> Auger O.D.�f /�— I.D. y[ M <br /> Drilling Company: Comleti <br /> pon - Stove i e <br /> /christie box <br /> P P (circle one) <br /> A <br /> Driller: �lP4 ( <br /> casing <br /> Consultant F_i 5.en 3 height <br /> Geologist 14N N6 <br /> ABOVE-GROUND .. <br /> SPECIAL PERMIT INFO. C0hF ET1ON CHR -Y=80X <br /> Ground Saiaca C. _ <br /> Distance tOMPLEMON <br /> o sewer line r <br /> Domestic well on site - (y/n) Grout <br /> If yes, location and distance - <br /> 68 ft. <br /> —22- O h. <br /> I — m <br /> SAMPLING <br /> N = <br /> Holding Temperature Coned <br /> /� +xyon 1 _ <br /> Method = <br /> Screening Method — Gn s7 Pack <br /> Tracking Sheet - FY/n) <br /> SPOILS <br /> —1—Z <br /> Storage Method 4-0 ,-ou-q <br /> Contamination Noted - (y/n) MATERIALS/DEVELOPMENT <br /> Storage Location <br /> Casing type PI/c, <br /> Blank ft. Screen Lo <br /> GROUPING Slot size ft. <br /> d.o/o <br /> Bags cement <br /> `� � <br /> Depth to water 7 T. Buckets bentonite_ r s fps <br /> Mix Ratios Bags sand/gravel <br /> Installation Method Filter Pack type/size <br /> Quantity Installed Surge Block: - n ) <br /> Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method <br />