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MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> (�L CONSTRUCTION ,C1tt,/� �AA�q <br /> (J U -- <br /> aS / 00 ( r � ' Total <br /> Premise Address: Depth <br /> Screen Length (?pipcluistle <br /> (to)- <br /> Well <br /> to) <br /> Well No.: tK 91-A Filter Pack ( (to) <br /> Bentonite ( (to) <br /> Inspector-. R 1 �" `? ` t Grout ( (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. . <br /> Completion - Stbox (circle one) <br /> kJ Drilling Company Driller. � _g <br /> Consultant ��/ IV -EW-F <br /> Geologist ABOVE-GRCUND <br /> COWPL.FT;ON ChWJ>L=- ON <br /> COMPLE7ICN <br /> SPECIAL PERMIT INFO. r G=rd Svfan <br /> prart <br /> Distance to sewer line I � <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - h. <br /> ft. <br /> SAMPLING luA— �lormi _ -E <br /> s 'en <br /> Holding Temperature = gravdyadc <br /> Method - S� <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> SPOILS ( r <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) // `r�,Pv <br /> Storage Location (Casing type V <br /> Blank ft. Screenft. <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: - CQ n ) <br /> Type of method �J <br /> EH 29 29 <br />