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r <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> ✓ TotalS <br /> Premise Address:_ Depth Screen Length (from) (to) <br /> Well No.. Z Filter Pack (from) (to) <br /> Bentonite (from) (to) u1t- <br /> Grout (fro ) (to) <br /> Inspector: Drilling rige S <br /> Auger O.D. 1.D. S 1 <br /> Permit No. Completion - Stove pipe/cluistie box (circle one) <br /> AK-- <br /> Drilling Company: — <br /> casing <br /> Driller ilm <br /> � height: <br /> • • ,• '9 <br /> Consultant /�L VwJ — � —CWT <br /> Geologist " ABOVE-GRCUND CHRZ Y-3ox <br /> OoNFLETiON c0WJ>LET1CN <br /> Ground Ststacs <br /> SPECIAL PERMIT INFO. <br /> grcut <br /> Distance to sewer linep <br /> Domestic well on site - (y/ n) n, <br /> If yes, location and distance - . <br /> O <br /> •forad _ <br /> SAMPLING soc'cn <br /> i vaY9t4C <br /> Holding T mperatur <br /> Method S � <br /> Screening Method <br /> Tracking Sheet n) <br /> SPOILS <br /> MATERIAIS/DEVEI.OPMENT <br /> Storage Method l(� " L <br /> Contamination Noted Q / n) Casing type P <br /> Storage Location Blank ft. Screen Z____�__ �' <br /> Slot size© ' <br /> Bags cement <br /> GROLITING Buckets bentonite <br /> ,v�bBags sand/gravel <br /> Depth to water Filter Pack type/size <br /> Mix Ratios________— Surge Block: - (y/n) <br /> Installation Method Discussed with geologist: - (y/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />