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4 <br /> •MONITORING WELL INSTALLATION REPOR <br /> NA U w- -i 1 <br /> Date: CONSTRUCTION <br /> Premise Address: b A Total Depth �dU CIT <br /> L . <br /> Screen Length (from) (to) <br /> Well No.: 0Q &LL G C Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: V4M Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. _ I.D. <br /> Completion - Stove pipe/chris[ie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> / height <br /> Consultant <br /> t-- <br /> Geologist Ai;yE-GgMND <br /> COMS�LETION CNAtSTY-80X <br /> COMPLEMN <br /> SPECIAL PERMIT INFO. Gr°"rd Sumacs <br /> grout <br /> Distance to se-sver line <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - ft. <br /> SAMPLING slorad <br /> aac�cn — <br /> Holding Temperature gn W Pack <br /> Method <br /> Screening Method C, _ <br /> Tracking Sheet - ( y/ n) _— <br /> �ft. <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/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ II ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />