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MONITORING WELL INSTALLATION REPfm�T <br /> Date: _ p CONSTRUCTION <br /> Premise Address:101L yz '✓ w Total Depth <br /> Screen Length (from) (to) <br /> Well No.: MtA) -3 Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/—Tu istie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> _eVT <br /> Consultant 7 T <br /> Geologist 19 <br /> ABOVE-GROUND CtiAIST 4= <br /> CO&FLETION COMPLEMN <br /> SPECIAL PERMIT INFO. Ground Surface T <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) ft. <br /> If yes, location and distance - <br /> = e <br /> SAMPLING slotted = c <br /> �/;� LeC90n <br /> 7 x. <br /> Holding Temperature � <br /> Method v A _ Pack <br /> Screening Method <br /> Tracking Sheet - - /n) <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/n) <br /> Quantity Installed Discussed with geologist: - (y/n ) <br /> Type of method <br /> EH 29 29 <br />