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MONITORING WELL INSTALLATION REP <br /> Date: �'/ CONSTRUCTION <br /> Premise Address: (J�JG � "J Total Depth 1� <br /> ( It l SZfI L , Screen Length (from) (to) <br /> Well No.: . G-fl 1 iU � Filter Pack (from)—(to)- <br /> Bentonite <br /> from) (to)Bentonite (from)—(to)- <br /> Inspector: <br /> from) (to)Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. 7geI.D. <br /> cluistie box (circle one) <br /> Drilling Company: SSiDriller:Consultant GeologistCNAI,Sl1'-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Susan <br /> Distance to sewer line of0 I <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - <br /> tt. <br /> — a <br /> m <br /> = o <br /> c <br /> SAMPLING sloned <br /> aacdon <br /> Holding Temperature <br /> Method = �� <br /> Screening Method <br /> Y> _ <br /> Tracking Sheet - (y/ n ) <br /> tt. = ft. <br /> SPOILS 7S <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ 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 o� Bags sand/gravel <br /> Mix Ratios t 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 />