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MONITORING WELL INSTALLATION REPORT <br /> Date:_ lU�v/U� <br /> CONSTRUCTION <br /> Premise Address: A7vo 7 c1 J 1 R4 <br /> Total Depth <br /> Well No.: AA 1,/k/, A4 '✓� Screen Length (from) <br /> Filter Pack (from) <br /> Inspector: Bentonite (from) <br /> Grout (from) <br /> Permit No. 5"6s-- ' Drilling rig type <br /> -- Auger O.D. I.D. <br /> Drilling Company: -),�A.�rti Completion - Stove pipe/christie box (circle one) <br /> Driller: <br /> casing <br /> Consultant < Ldv height <br /> Geologist T <br /> ABOVE-GROUND T <br /> SPECIAL PERMIT INFO. COMPLETION CHRtm-80XCOMPLETION <br /> Ground Surface <br /> Distance to sewer line <br /> Domestic well on site - (Y/ nGfout <br /> ) <br /> If yes, location and distance <br /> _ p <br /> SAMPLING <br /> — m <br /> �btted — c <br /> Holding Temperature mon = <br /> Method = I&vW pack Method <br /> Tracking Sheet - ( /n ) <br /> SPOILS n• <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location <br /> Casing type <br /> Blank ft. Screen R <br /> GROUTING Slot size <br /> Bags cement <br /> Depth to water <br /> Buckets bentonite <br /> Mix Ratios Bags sand/gravel <br /> Installation Method Filter Pack type/size <br /> Quantity Installed Surge Block: - (y/n ) <br /> Discussed with geologist: - (y/ n ) <br /> EH 29 29 Type of method <br />