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MOMTORING WELL INSTALLATION REPORT f <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth z o <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: - _6hn� Grout (from) (to) <br /> Drilling rig type I FcJ ZQ u w)C.l-� <br /> Permit No. ��' i9�� Auger O.D. I.D. <br /> �� ��• Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: lta(9– <br /> Driller: 32L casing <br /> height <br /> Consultant F:2A 1-71 <br /> T <br /> GeologistN LL– '4m to <br /> AWYE-GROUND CHRIM-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line G grout <br /> Domestic well on site - (y/n) ft. <br /> If yes, location and distance - ft- <br /> ft. <br /> w1 <br /> .�. <br /> SAMPLING <br /> Sas ftV,;il� L� abt•.a.� M <br /> sacdcn — <br /> Holding Temperature Se&u Bt A LApack <br /> <" <br /> Method : <br /> s <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> Storage Method S I tl'> J Grr MATERIALS/DEVELOPMENT <br /> Contamination � S <br /> Note'ii y(�n ) <br /> Storage Location D l� u (P Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water -31 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 />