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,MONITORING WELL INSTALLATION REPORT <br /> Vj <br /> Date: dm00 CONSTRUCTION <br /> Premise Address:_ + J O `^ Total Depth <br /> I Screen Length (from) (to) <br /> Well No.: - ( Z, Filter Pack (from) (to) <br /> Bentonite (from) __ (to) <br /> Inspector: _ Grout (from) (to) <br /> Permit No. <br /> Drilling rig type <br /> 6���S�Z Auger O.D. I.D. <br /> Drilling Company: �n-e <br /> Completion - Stove pipe/christie box (circle one) <br /> 77— <br /> � 5 <br /> Driller: casing <br /> 7F <br /> Consultanr_ C&2_ <br /> F height <br /> Geologist l \ <br /> ABOV:-GR CUND <br /> COMPLETION C_fR*TY-80x <br /> SPECIAL PERMIT INFO. QCOWL.EnON <br /> rovcd Saiacs �.+ ..�..�,� <br /> Distance to sewer line orcut <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - 4 <br /> o...�._...fi. ft. <br /> m <br /> _ r <br /> SAMPLING g <br /> dorsi _ 'c <br /> Holding Temperature <br /> Method VIVW Pack <br /> Screenin;Method <br /> Tracking Sheet - ( y/ n ) <br /> �.._.ft. ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen fr, <br /> GROUTING Slot size <br /> Bags cement <br /> Buckets bentonite <br /> Depth to water /G Bags sand/gravel <br /> Mix RatiosZ Filter Pack type/size <br /> Installation Methods w Surge Block: - ( y/ ti ) <br /> Quantity Installed U Discussed with geologist: - (y/ n ) <br /> EH 29 29 <br /> Type of method <br />