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MONITORING WELL INSTALLATION REPOKT <br /> Date:, G�1���� CONSTRUCTION <br /> Premise Address: Total ry✓l L�'iK�a �-��-t/ Total Depth <br /> Screen Length (from) (to) <br /> Well No.:' Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christle box (circle one) <br /> Drilling Company: <br /> Driller: casing , <br /> cc,,�� height <br /> Consultant �` <br /> I-;- }� � �► <br /> Geologist `�. - ° �`'�- '� _ - <br /> JI$OYE-GFtCUNfl q-tRtSTY-c3OX <br /> OOWLET N compo N <br /> SPECIAL PERMIT INFO. Gmurd Suiaaa <br /> Distance to sewer line 4rocrt <br /> Domestic well on site - (y/n ) it. <br /> If yes, location and distance - <br /> • l#. <br /> SAMPLING slaro� _ <br /> • xot�cn � <br /> Holding Temperature <br /> MethodF- <br /> Y <br /> Screening Method +`"• <br /> Tracking Shcet - (y/n ) <br /> tt. tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - {y/n) <br /> Storage Location Casing type <br /> Blank ft- Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/graveI <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/it ) <br /> Quantity Installed Discussed with geologist: - {y/n) <br /> Type of mahod <br /> EH 29 29 <br />