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• MO"TORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: f N f� (� Total Depth 9 <br /> Screen Length (from) (to) <br /> Well No.:_T 20 Filter Pack (from) (to) <br /> k Bentonite (from) (to) <br /> Inspector- FYI Grout (from) (to) <br /> Drilling rig type f 6V-o tac tF <br /> Permit No. q1- l w� Auger O.D. I.D. <br /> Drilling <br /> Completion - Stove pipe/christie box (circle one) <br /> Compan;�y.�:,��� �7°�'��I�LU�{U(Q- <br /> Driller: 1 � &Vssw, casing <br /> height <br /> n <br /> Consultant� /1 1- <br /> T <br /> �t w�r <� <br /> Geologist »• <br /> ABOVE-GROUND C 4MM-80X <br /> CONFLEMN COMPLEMN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> rout <br /> Distance to sewer line g1 <br /> Domestic well on site - (y/ n ) T ft. <br /> If yes, location and distance - <br /> �.ft. ft. <br /> Vp O <br /> SAMPLING .�I J��7 slored <br /> M <br /> sadcn <br /> Holding Temperature <br /> Method __ gr%VW Pack <br /> Screening Method — <br /> Tracking Sheet - (y/ n ) <br /> .x <br /> �_.ft. fL <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 />