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x R s <br /> j <br /> MONITORING WELL INSTALLATION REPORT <br /> I <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth 3 <br /> Screen Length (from) <br /> WellNo.: PAW - f Filter Pack (from) $ to) ' <br /> — , <br /> Inspector. Bentonite (from)_ G,' (to)- <br /> Grout (from) (to) <br /> i <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. j <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> Driller: i <br /> �_.. casing j <br /> he-ight <br /> Consultant <br /> _EWT <br /> Geologis A . -4 <br /> Ascv€-cacuHD , <br /> CWtvQLETCN Ck•RZ Y_aox " <br /> SPECIAL PERMIT INFO. C0tAPt.__nCN <br /> cra:�d suss, <br /> 3 , <br /> Distance'to sewer line' flrcut <br /> Domestic well on s' - y/ n) <br /> ,If yes, Ioeati d distance <br /> t <br /> 10 <br /> r <br /> SAMPLING • c <br /> `4 t ilorw� _ c <br /> "HoldingTempera=e rr, y :acicn <br /> Method _ VIY,!pad(' , <br /> Screening Me od p <br /> Tracking Shcet -0/ n ) n -r <br /> SPOILSf - <br /> - , .:ate 4 • , .. <br /> Storage Method S-S k <br /> Contamination Noted • ( MAIElALSlDEVEJ•OPMENT, <br /> Storage Location ;l F vL <br /> S Casing type <br /> I # f. - Blank—, 0 ---ft' Screen <br /> GREGy l) ` SIOt Size s o-1 O + " <br /> Bags cement <br /> 'Buckets bentonite' - <br /> Depth to water _ Bags sand/gravel S- <br /> Mix Ratios .+.. Filter Packc size <br /> Installation Method / -- --� T�"" <br /> Quantity Insta]led ; ' ' - Surge Block: - (y/ 2 <br /> Discussed with gco gist: - ( y-ln <br /> FH 29 29 ?� : ". " <br /> Type of rnctliod �/ <br />