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MONITORING WELL INSTALLATION REPORT <br /> Date:_ ( ( ��!`'/ CONSTRUCTION <br /> Premise Address: <br /> Total Depth o� <br /> Well No.: Im — Screen Length (from)_ ) (to) <br /> Filter Pack (from) I <br /> Inspector: Bentonite' (from) (to)_ BL-� _ <br /> Grout (from) <br /> S sI0�� Drilling rig type .—L 1 /Ka-t1� <br /> Permit No._ Auger O.D. Tj�' <br /> Drilling Company: <br /> Completion- Stove pipe •'stie bo circle one) <br /> Driller: jlyt casing <br /> / , height <br /> Consultant 1A <br /> Geologist <br /> ABOVE-dRCXJND <br /> CoNFL.ETION CHRIS-rY480X <br /> SPECIAL PERMIT INFO COMPLEricN <br /> Ground Surfaca <br /> Distance to sewer line graft <br /> Domestic well on site - (y/n) <br /> If yes, location and distance- h. <br /> 1. ft. <br /> ft. <br /> SAMPLING Y• — o <br /> 510 <br /> ttpd — c <br /> Holding Temperature <br /> Method v2M pack <br /> Screening Method _— <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method CjAj CA l 2s4 MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n} l <br /> Storage Location_�1•�-��� Casing type S q <br /> Blank 1 ft. Screen J S ft. <br /> Slot size �� <br /> GROUIING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size # 5 <br /> Installation Method <br /> Quantity Installed Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method <br />