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MONITORING WELL INSTALLATION REPORT <br /> Date: O CONSTRUCT70K <br /> . -1'tti.aD r n� <br /> Premise Address: Total Depth <br /> Well No.: _4 Screen Length (from) '-1 S <br /> _ Vf Filter Pack (from) ' [ ) <br /> Inspector. Bentonite (from)_3C-41h <br /> Grout (from) -9 {to) ' <br /> Permit No. ~ Drilling rig type i <br /> Auger O.D. I.D. <br /> Drilling Company; Completion - Stove pipe/cliristie box (cixcle one) <br /> Driller. <br /> casing i <br /> ConsultantheLght <br /> Geologist <br /> .4.80YE-GROUND <br /> G-SZ7Y-30X <br /> SPECIAL PERMIT INFO. �PLTICN <br /> Ground sulact <br /> Distance to sewer line prcut <br /> Domestic well <br /> ]f yes, locatio and distance <br /> i r t <br /> SAMPLING t ! <br /> Holding Temperature <br /> Method <br /> Screening?vlethod , <br /> Tracking Sheet - (y/ n ) <br /> ✓ i. <br /> SPOILSti. <br /> t <br /> AS I A_f( �VS�/�LC A <br /> Storage Method ," «. <br /> Contamination Noted - �' ' MATERIALS EVEI.OPMENT <br /> Storage Location {Y�, <br /> Casing type '`'� _,i ,. <br /> ' Blank ft: Screen <br /> GR, LmING. SIat size , <br /> r Bags cement <br /> Depth to water .N C)' , 'Buckets bentonite <br /> MiXYRados r Bags sand/gravel <br /> Installation Method Filter Pack type/size r <br /> Quantity Installed Surge Block: - (y/ I2 ) <br /> s Discussed with geologist -'(y/ n ) <br /> EH 29 29 r Type of method <br />