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MONITORING WELL INSTALLATION REPT D.T <br /> Dater/ CONSTRUCTION <br /> Premise Address: <br /> Total Depth <br /> Screen length (from) (to) <br /> Well No.: 44'� Filter Pack (from) (to) <br /> Bentonite (from) / (to) <br /> Inspector: L- 0 e _ —_ Grout (from).- (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/du-istie box (circle one) <br /> Driller: casing <br /> tq,7 <br /> height <br /> Consultant �� � �� <br /> Geologist T <br /> ABOVE-GROUND 1 <br /> COMPL.ET{ON I CHRZ7Y-SOX <br /> COMPLEnON <br /> SPECIAL PERMIT INFO. Ground ulwo <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) ft <br /> If yes, location and distance - <br /> fi. <br /> ft. <br /> C <br /> SAMPLING <br /> — o <br /> slag! c <br /> 1 aeon <br /> Holding Tem erature r <br /> Method <br /> Screening Method j4&L <br /> Tracking Sheet - n ) —_ <br /> SPOILS <br /> Storage <br /> Minn Noteds(y n ` 1 RIALSIDEVELOPMENT <br /> ConStorage Location � <br /> g Casing type--�-_P.) <br /> Blank ft. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> ,r� ��ff Buckets bentoni <br /> Depth to water_4J - L(L 1V Bags sand/gra el <br /> Mix Ratios Filter Pack e/size <br /> Installation Method Surge Blocky - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />