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: MONI'T'ORING WELL I STALLATZON REPORT <br /> Date: ' If 13119Y <br /> CONST RUCTTON <br /> Premise Address: Z O W y� <br /> Total Depth .3 z- kwb, O <br /> Well No.: p� � Screen Length (from:)_ <br /> Filter Pack (from) (to) <br /> Inspector: Bentonire (from) <br /> . Grout <br /> Permit No. U Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company: A I Completion -.Stove pipe/christje box (circle one) <br /> Driller. <br /> F casing <br /> Gonsc:Itanr 11 height <br /> 4 <br /> Geologist - <br /> ABOVE-GRCUND <br /> SPECIAL PERMIT INFO. COMPLMN <br /> T M7 <br /> �Gt-A;5TYL_`Tl�30X <br /> Groc rd Stsix�t PcN <br /> Distance to :ewer line <br /> Domestic well on site - n ) flrccrt <br /> I:yes, location istance - <br /> - <br /> SSG <br /> Holding Temperature taco <br /> Method <br /> Screening od <br /> TrackiRXcet (y/ n ) <br /> :C <br /> f tr. <br /> Storage Method <br /> Contamination Noted - (y/ � I�IATEWAL S/i�FVEI,OPMENT <br /> Storage Location <br /> Casing type <br /> Blank fr• Screen <br /> GR \NG SIot sizefT• <br /> MA 11 r <br /> Bags cement <br /> Depth to `rater /V } Suekcts bentonite <br /> Mix Ratios Bags sand/gravcI <br /> Installation Method Filter Pack type/size' <br /> Quantity Installed ti Surge Block. - <br /> (y-/ t� <br /> Discussed with geologist: - ( y4 <br /> EH 29 29 Type of rnetliod <br />