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• <br /> MONITORING WELL INSTALLATION REPORT <br /> o <br /> CONSTRUCTION(� <br /> Date: X) ; <br /> \ Total Depth. 1�5" <br /> Premise Address: Screen Length (from) (to) <br /> Filter Pack (from) <br /> Well No.: ���� Bentonite (from) (to) do_' <br /> Grout (from) (to) <br /> Inspector: �° Dulling rig type <br /> Auger O.D. S%" I.D. t/5/1 <br /> permit No. Completion-Stove pipe/christie box (circle one) <br /> Drilling Company. <br /> casing <br /> Driller: height <br /> . 7 � <br /> Consultant <br /> Geologist A_Z-.)V=-.GROUND CHR, -gc*^, <br /> Grxtr�c'Scs'tacY �, <br /> SPE AL PE '" INFO. <br /> procrt <br /> Distanc o sewer line V <br /> Domes c ell on site - (y/ n) �'� <br /> c w i� <br /> If y , local n and distance - 1 <br /> slatsad <br /> SAMPLING72V94 Pad( <br /> Holding Temperature =_ <br /> Method <br /> Method r — <br /> Screening -- <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> RIALS/DEVELOP.W.— <br /> Storage Method <br /> Contamination Noted - (y/ n) Casing type <br /> "AZ �+ <br /> Storage Location Blank f1_- Screen t -U-lf <br /> Slot size 5w <br /> _GROUTING <br /> Bags cement <br /> � <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter*Pack typesize <br /> Mix Ratios -Surge Block - (y/ n ) <br /> installation Method Discussed with geologist - (y n ) <br /> Quantity Installed Type of method <br /> Eli 29 29 <br />