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VON'ITORING'WELL INSTALLATION REPOR <br /> 'Alt, V <br /> Z'S <br /> Dater10 11 4,3,1 gONST.RUMON <br /> Premise Address: Total Dep <br /> Screen Length (from) <br /> Well No.: Filter Pack, (from) <br /> Bentonite (from) —(to) <br /> Inspector. Grout (from) —00) <br /> Drilling rig type�_�.���, <br /> Permit No. Mger 0.6. <br /> Completion-Stove piWouistie box (circle one) <br /> Drilling Company- <br /> �' i-Driller- 71casing- <br /> he, ht <br /> Consultant , <br /> Geologist <br /> ABO�t4SCimo <br /> CC&PLETICN CHR$tmaox <br /> c4mPLEnON <br /> LPLC_TAL,PERMIJ INFO Gmr)d Su—rfw— t <br /> A <br /> Distance to sewer line W0, <br /> Domestic well on site (y/n:)- <br /> If yes, location and distance - en <br /> SAMPLING <br /> Wortod <br /> saclen <br /> Holding T, a <br /> Method 6 <br /> Screening Method <br /> Tracking Sheet - n) <br /> ir <br /> SPOILS <br /> -Storage Method MATERIA§M9VELOPMENT <br /> Contamination Noted--(y/.n) <br /> Storage Location, Casing type <br /> Blank ft. Screen ft. <br /> Slot size- <br /> GROLITING Bags cement <br /> Buckets bentonite <br /> i 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 /> EH2929: <br />