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MONITORING WELL INSTALLikTION REPORT <br /> 6 D CONSTRUCT IOM <br /> Total <br /> Premise Address: Screen Length (from) (to) <br /> Filter Pack (from) (to) <br /> Well No.: �l I_` Bentonite (from) (to) <br /> Grout (from) <br /> Inspector. ming rig type <br /> Auger O.D. I D. <br /> Permit No. Completion- Stove pipe/chrisrie b°� Ccircle one) <br /> er <br /> Drilling Company <br /> casino <br /> Duller. 7FM6LIT height , <br /> Consultant <br /> j,* <br /> ty <br /> Geologist CSP`=i1CN <br /> cc <br /> tvPL:iION�O� <br /> acs , <br /> SP-CIAL P-RM1 T IN"0• pros: <br /> Dis=ce to sewer line ♦ fL <br /> Domestic well on site - C Y/ n ) fL /$��S <br /> If yes, location and distance - - = i (6,24o <br /> z 5��# <br /> -35 <br /> SAMPUNC sacton <br /> Holding Temperature F. <br /> Method ;r = <br /> Screening Method - <br /> Tracking Sheet - (Y/ n) _ _ ♦ IL <br /> SPOILS <br /> MA-I��glAis/DEVEI,OPMENT <br /> Storage Method <br /> Contamination Noted - (Y/ n ) Casing type l r. d ft. <br /> Storage Locarion Blank ft Screen <br /> Slot size v <br /> Bags cement <br /> GROUITNG � �V / Buckets bentonite <br /> vBags sand/gravel 2 Sunil <br /> Depth to water Filter Pack typesize <br /> Mix Ratios �� �� .Surge Block: - C Y/ n ) <br /> Installation Method Discussed with geologist <br /> - Cy/ n) <br /> Quantity Installed ' Type of method <br /> ETI 29 29 <br />