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MONITORING WELL INSTALLATION REPORT <br /> Date: /bVP S CONSTRUCTION <br /> Premise Address: S� Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Ati wS Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from)-(to)— <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> Consultant <br /> Q /)IU/ height <br /> + T <br /> Geologist L T <br /> ABOVE-GROUND <br /> COMPLETION CHRMTY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Qmund gurfYy <br /> Distance to sewer line Ori <br /> Domestic well on site - (y/ n) �—e <br /> If yes, location and distance - R <br /> ft. <br /> yA m <br /> SO. <br /> c <br /> SAMPLING <br /> r/ <br /> Z <br /> abttad _ <br /> Holding Temperature T �Ci Pack►�+on _ _ <br /> Method = QMVW P <br /> Screening Method E(, ' — <br /> ti <br /> Tracking Sheet <br /> h. = g, <br /> SPOILS /� <br /> Storage Method� _ nAgxi, MATERIALS/DEVELOPMENT <br /> Contamination Noted - / n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water X5`96 ! 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 /> EH 29 29 Type of method <br />