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MONITORING WELL INSTALLATION REPORT <br /> Date:_ CONSTRUCTION <br /> Premise Address:_ Total Depth <br /> Well No.: Screen Length (from) (to) -70 - <br /> Filtet Pack <br /> Bentonite* (from) .0`/ (to) S 7 <br /> Inspector: Grout (from) 0.5— <br /> Drilling <br /> 5—Drilling rig type k -7S" <br /> Permit No. Auger O.D. T I,D. 4j, r <br /> MW <br /> n f <br /> Drilling Company:_ Completion - Stove pip e box�eircle one) <br /> ��l - (�+��I Christi <br /> Driller: V cu Com_ casing <br /> n height <br /> Consultant_ <br /> Geologist vt AA,(I -. <br /> ABOVE-GROUND <br /> CO rFL.Ef{ON C�IRISTY-BOX <br /> COMPLEn0N <br /> SPECIAL PERMIT INFO. Grcur)d Sul;6ce <br /> Distance to sewer line flrocrt <br /> Domestic well on site - (y ) <br /> If yes, location and distance - ft. <br /> • � m <br /> C <br /> SAMPLING IUd 47 5 - <br /> t to tte-d c <br /> • sac~San — � <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method Sc 1� &Vl Mt TER1ALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location (' Casing type k'Ji_ �j(,� yo <br /> Blank ft. Screen 10 ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite' <br /> Depth to water Bags sand/gravel <br /> Mix Ratios 3 Filter Pack type/size__ _ $Ic- <br /> Installation Method __ Surge_Block: - ' n_) _ <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> EH 29 29 Type of method - <br />