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MONIT `T�CryygLL INS•I•ALLATION REPORT <br /> CONSTRUCTION <br /> Premise Address: 5 Goo w.t&-, Total Depth 3 h 3 Z U& &,k 'Vo <br /> Well No.: Screen Length (from) (ro) <br /> Filter Pack (from).(to) <br /> Inspector. Bentonite (from) (Co), <br /> Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: 6A&Orn <br /> Com on - Stove pipe/cluistie box (c— it e) <br /> Cons lmt a;Sht <br /> h fight <br /> .Consultant_(^ tPl- _ + . <br /> st_ <br /> Geolo gt iI A l <br /> !.PAVE-GRO(jND <br /> COWPL.ETION cl-s 5TY-aox <br /> SPECIAL PERMIT INFO. COMPLE7ICN <br /> nd Sun <br /> sa <br /> Distance to sewer lin grout <br /> Domestic well on site - (Y/ n) <br /> If yes, location and distance - v1� 7 ll <br /> ft. ft. <br /> SAMPLING <br /> tlorai — c <br /> Hold ingTemperature- <br /> Method = p•awtyat <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVEt OpMENi• <br /> Contamination Noted - (y/n ) / <br /> Storage Location Casing type_�M� <br /> Blank fr Screen h. <br /> GROUTING Slot size <br /> Bags cement <br /> Depth to water Al Buckets bentonite <br /> 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. . <br /> Type of method <br />