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MONITORING WELL INSTALLATION REPORT <br /> CONSTRUCTION <br /> Date: <br /> $ , dc.5� Total Depth <br /> Premise Address: 3 7 iv�� Screen Length (from) <br /> Filter Pack (from) �//' (to) �y <br /> Well No.: '`�' <br /> Bentonite (from) 9 <br /> 5 <br /> Grout (from) <br /> Inspector: C"' o-7- Drilling rig type 5 <br /> Auger O.D. S " I.D. t( VY <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company casiniaic <br /> Driller: �% / � heightConsultantGeologist �� �^ ABOYEwAOUND <br /> G=nd Salacs <br /> SPECIAL PERNU i INFO. <br /> proof <br /> Distance to sewer line j S ft. <br /> Domestic well on s' - (Y/ n ) �� ft.- <br /> If yes, location d distance �({ <br /> a <br /> slotted = c <br /> SAMPLING section - <br /> Holding Temperature <br /> Method <br /> M <br /> Screening Method <br /> Tracking Sheet - y/ n) JL <br /> SPOILS <br /> o-41- b MATE UALS/DEVELOPMENT <br /> Storage Methodw•- <br /> Contamination Noted - (y/Q) Casing type IAV c- <br /> Storage LocationScreen —ft. <br /> Blank � ft. <br /> Slot size ,-­ Z <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> 3 $ YL Bags sand/gravel Z 42 <br /> Depth to Ovate_* G Filter Pack type/size <br /> a-10 <br /> Mix Ratios Surge Block: - ((p n ) v `� <br /> Installation Method <br /> Quantity Installed ^J Discussed with geologist: - (a n ) <br /> Type of method <br /> EH 29 29 <br />