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MONITORING WELL INSTALLATION REPOnt <br /> Date: -2 CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) S (to) 20 <br /> well No.: 1..7 Filter Pack (from) (to) 2 b <br /> Bentonite (from) (to) 3 <br /> Inspector: Grout (from) (to) <br /> 5 O Drilling rig type �M a�SCS <br /> Permit No. I ( ` -I Auger O.D. I.D. <br /> Drilling `I W 1 0 Completion - Stove pi christie box (circle one) <br /> c�Company: V J S-N/� �-, <br /> Driller. 1�S✓:ie GLA.Z t-� casing <br /> � r- 8 height <br /> Consultant G✓�g� C• <br /> Geologist &�2, <br /> ABOVE-GROUND CNAIS'1Y-BOX <br /> CO!�LETION COMPLE oN <br /> SPECIAL PERMIT INFO. Ground S <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n) .� 2. . f <br /> If yes,location and distance - 3 <br /> C <br /> SAMPLING N/ slottad <br /> soctian <': <br /> Holding Temperature <br /> Method <br /> Screening Method = <br /> Tracking Sheet - Cy/ n) <br /> SPOILS <br /> Storage MethodFed'. <br /> � -S MATERIALS/DEVELOPMENT <br /> Contamination No ed - (y n 2ff <br /> Storage Location-0 c>--g Casing type <br /> Blank__-:5 _ft. Screen / f <br /> Slotsize -Cee ' <br /> GROLPfING Bags cease t <br /> p Buckets bentonite <br /> Depth to water � 'E �t 2 ^ccs 1J Bags sand/gravel� <br /> Mix Ratios Filter Pack type/size #� <br /> Installation Method r•es_ Surge Block: - yW n) <br /> Quantity Installed Discussed with geologist: - ( n) <br /> Type of method <br /> EH 29 29 <br />