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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCI'IM <br /> 1.r ise Address; W Total L)epth <br /> Screen Length (from) (to). <br /> WeII Altw` ~ A AV Filter Pack (to) <br /> Bentonite {froiny {to) <br /> Inspettort. Grout (fvw) { ) <br /> Drilling rige <br /> Permit lVo, Auger 0.0 I:D. <br /> Completion•Stovipe%lu'istie box {eir <br /> e pcle one) <br /> Drilling Company <br /> Driller: .,..casing <br /> he ilhi <br /> Consultant -00 <br /> Geologist <br /> ABOVE-GAOUNn <br /> COMPLETION <br /> gPECIAL PERMIT INFO. Ground Surto+� <br /> Distance to sewer line <br /> Domestic well on site• (y/n} ft <br /> Ifyes, location and distance- fL <br /> SAMPLING srad <br /> sacicn <br /> Holding Temperature °ice wt <br /> Method <br /> ScreeninlyMethod � <br /> Tracking Sheet - Y n} x <br /> 41a wµr w� -I is. <br /> SPOILS <br /> Storage Method MATERIALSMEVEI.OPMENT: <br /> Contamination_Noted-:{y.:f. i}. <br /> Storage Location Casing type <br /> Blank fL Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth xa zya#er Bags sandlgratv�el <br /> Mi�c;Rattas Filter pack tlrper.siue <br /> Installation Method Surge Block:. <br /> Quantity Installed Discussed with geologist: - (y 1 n). <br /> Type of method <br /> EE-I '29 <br />