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MONITORING WELL INSTALLATION REPORT <br /> Date: Zcc, CONSTRUCT!ON <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.•_.. (�)�_)_ _ Filter Pack (from) (to) <br /> Benronite (from) (to) <br /> Inspector. Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. 1 I.D. <br /> Drilling Company: A&- - Lm, <br /> Completion - Stove pipe/cluzstie box (circle one) <br /> Driller• caging <br /> height <br /> Consultant t uJ IV V <br /> , p <br /> Geologist <br /> 11 I" —QVT <br /> ABOVE-GRCUND C sRZ7Y-aox <br /> 00 WL_FrCN COM�L_rnCN <br /> SPECIAL PERMTT INFO, p ��S�sisct <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - tt- <br /> It. <br /> m <br /> - r <br /> SAMPLING <br /> lJorod <br /> s acicn <br /> Holding Temperature CC-), — <br /> Method <br /> Screening Method <br /> Tracking Sheet n ) -' <br /> �. <br /> 4 <br /> SPOILS <br /> Storage Method AA MATERIALS/DEVELOPMENT <br /> Contamination Noted - rte/ ) ,t r <br /> Storage Location rlv\ Casing type—AL <br /> V <br /> Blank ft Screen ZO ft. <br /> SIot size , o0ZC? - <br /> GROUTING Bags cement <br /> r !! Buckets bentonite <br /> Depth to water 14 7 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size z 2_ <br /> Installation Method Surge Block; - (y/ 1 <br /> Quantity installed Discussed with geo ogist: - ( y <br /> Type of mcthod <br /> EH 29 29 <br />