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r <br /> MONITORING WELL INSTp,I,I,ATION REPORT <br /> CONSTRUC'T'ION <br /> Date: ��� �� � <br /> Total Depth �� <br /> .�� (from) <br /> -- <br /> Premise Address: �� Screen Length ( <br /> Filter Pack (from) (to) — <br /> Well No.: �'"� 'Y u 7 Bentonite (from) (to) <br /> (to) <br /> Grout (from) <br /> Inspector. Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. 40 464U Completion - Stove pipe/christie box (circle one) <br /> I <br /> G�� <br /> Drilling Company: <br /> _ <-� casing <br /> Driller: — height <br /> Consultant <br /> Geologist ABOVF-GRCUND a-slY-80X <br /> COMPLETCN COMPLETICN <br /> Ground Surtacs <br /> SPECIAL PERMIT INFO. <br /> pout <br /> Distance to sewer line -it. <br /> Domestic well on site - (y/(T) ft. <br /> If yes, location and distance - rs"SAMPLING <br /> iocicn <br /> Pack <br /> Holding Temperature g'YOl <br /> Method 30 <br /> Screening Method CA _ <br /> Tracking Sheet - n) <br /> y0 �.+._ft. ft. <br /> SPOILS pt a06" <br /> Storage Method S� MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location L s�� Casing type <br /> Blank ft. Screen--.ft. <br /> Slot size t G llm a a - <br /> GROU71NG Bags cemen <br /> Buckets bentonite <br /> y�(,J Bags sand/gravel <br /> Depth to water 3 2" Filter Pack type/size 2 2- <br /> Mix Ratios _ <br /> ii ) <br /> Installation Method Surge Block: - 0 <br /> Quantity Installed Discussed with geologist: - (,j/ n ) <br /> Type of metliod (r�r,r✓� l� <br /> EH 29 29 <br />