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ONITORING WELL INSTALLATION REP( <br /> Date: 7 " /Z- CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) 86:� ' (to) <br /> Well No.: WU) Filter Pack (from) 86•f (to) <br /> Bentonite (from) (to) <br /> Inspector: �� Grout (from) (to) <br /> / Drilling rig type .5-'Don".9✓ <br /> Permit No. �('��-2 Auger O.D. I.D. <br /> Completion - S e/christie box (circle one) <br /> Drilling Company /�/ <br /> Driller: ��� casing <br /> height <br /> Consultant <br /> Geologist -- _- <br /> A840 CHRfM-80X <br /> CO WPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground SLewe <br /> Distance to sewer line <br /> 50 grout <br /> Domestic well on site - / n ) <br /> t. <br /> If yes, location and distance - 7 �L <br /> /5- f/ f <br /> �_2tt- <br /> SAMPLING <br /> soden <br /> Holding Temperature Z; '— VIYW Pack <br /> Method <br /> Screening Method "r <br /> Tracking Sheet - ( y/ n ) _ <br /> ft. = fL <br /> SPOILS / l 5 <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Note - (y/a) /01,-C <br /> Storage Location Casing type <br /> Blank ft. Screen <br /> Slot size in <br /> OUTING `�i. � ement <br /> / tonite <br /> Depth to water Bags San vel <br /> Mix Ratios F ter Pack type/size -3 <br /> Installation Method Du st/ Surge Block: - (�/ n ) <br /> Quantity Installed Tom_ Discussed with geologist: - (-y/ n ) <br /> Type of method <br /> EH 29 29 <br />