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0 0 <br /> MONITORING WELL INSTALLATION REPORT <br /> Date:_f 3�G CONSTRUCTION <br /> Premise Address:_ S Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from)_(to)— <br /> Bentonite <br /> from) (to)Bentonite (from) (to) <br /> Inspector. Grout (ham) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller: I casing <br /> height <br /> Consulrant A66 '9 <br /> Geologist <br /> ABOVE-GRCUND ChA15TY80X <br /> COt fPIETKJN C MPUMON <br /> SPECIAL PERMIT INFO. Ground Sutacs <br /> Distance to sewer line <br /> prart <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - <br /> R ft. <br /> = m <br /> — w <br /> — o <br /> — C <br /> SAMPLING ilor. d = 'E <br /> sadcn <br /> Holding Temperature T <br /> Method /7U A, �r'Y°�pack <br /> Screening Method 2- <br /> Tracking Sheet n) — <br /> tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen h. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> 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 /> EH 29 29 <br />