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r <br /> 'MONITORING WELL INSTALLATION REPOR:r <br /> Date: 1 D� CONSTRUCTION <br /> _ � J <br /> Premise Address: ' `l S� Total Depth �" �•6S <br /> J Screen Length (from) (to) <br /> Well No.: C?�` ���L`l �/ 2 Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cl stie box (circle one) <br /> Drilling Company:_ <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist "/• ��• ZG� <br /> ABOVE-GACUND CKRSTY-s30X <br /> COMPLETION COMPL.rEMN <br /> SPECIAL PERMIT INFO. Ground Sul <br /> Distance to sewer line orad <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - ft, <br /> ft. <br /> — C <br /> SAMPLING <br /> o <br /> (�'�G soden <br /> Holding Tem erature I cu" / <br /> p � - � (n,, L� ✓tom �' �1Y41 yaCfC <br /> Method (/!� <br /> Screening Method <br /> Tracking Sheet - (y n) : _ <br /> �• — <br /> Jt. <br /> SPOILS <br /> Storage Method Aj/ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) <br /> Storage Location Casing type l� <br /> Blank ft. Screen �• <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 />