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MONITORING WELL INSTALLATION REPORT <br /> Date-45ho CONSTRUCTION <br /> Premise Address: ] S �� MA <br /> Total Depth l�' <br /> Well No.. ! Z , C.iNy( Zd, Screen Length (from) (to) <br /> "cam Filter Pack (from) (to) <br /> Inspector: Bentonite (from) (to) <br /> Grout (from) (to) <br /> Permit No. Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company: P_.( (✓p�F� apt Completion - Stove pipe/christie box (cir— cle— o <br /> Driller: <br /> 1 4 T casing <br /> ConsultantC ♦1♦ height <br /> Geologist_01�'(_'.i —W–f <br /> A80VE-GROUND <br /> COAFLETCN CHR M43OX <br /> SPECIAL PERMIT INFO COMPLETION <br /> Around Surface <br /> Distance to sewer line orout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - _ft <br /> ft ft. <br /> y4 0 <br /> O <br /> SAMPLING c <br /> 0 <br /> dotted — 'c <br /> Holding Temperature +ec5on <br /> Method _ gmvel pack <br /> Screening Method <br /> Tracking Sheet - (y/n ) <br /> 4. — <br /> wi = <br /> SPOILS <br /> Storage Method <br /> Contamination Noted - (y/n) MATERIALS/DEVELOPMENT <br /> Storage Location Casing type <br /> Blank Screen <br /> h. <br /> GROUTING Slot size <br /> Bags cement <br /> Buckets bentonite <br /> Depth waterZ Bags sand/gravel <br /> Mix Ratios _ Filter Pack type/size <br /> Installation Method <br /> Quantity Installed Surge Block: - (y/ n ) <br /> Discussed with geologist: - (y/ n ) <br /> EH 29 29 Type of method <br />