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J `J <br /> MONITORING WELL INSTALLATION REPORT <br /> CONSTRUCTION <br /> Date: <br /> Total Depth (to) <br /> Premise Address: 7 Screen Length (from) <br /> Filter Pack (from) (to) <br /> Well No.: Bentonite (from) (to) <br /> Grout (from) (to) <br /> Inspector: Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: height <br /> Consultan <br /> Geologist AiOVE-GRCUND C�iRim-3ox <br /> 0OWPLF-TION COMPLETION <br /> Ground Sutact <br /> SPECIAL PERMIT INFO. <br /> pra.T <br /> Distance to sewer line <br /> Domestic well on site - (y/n} . <br /> If yes, location and distance - <br /> .q. <br /> V, <br /> Q <br /> SAMPLING (/ lot=ion <br /> 9MYS,Pack <br /> Holding Temperature I ... <br /> Method t iVV12M' '' is —_ <br /> Screening Method <br /> Tracking Sheet - ( / n) <br /> SPOILS_ <br /> MATERIALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted - (y/n} Casing type <br /> Storage Location Bla ft. Screen <br /> Slot size <br /> Bags cement <br /> GRA G Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - (y/ n ) <br /> Installation Method Discussed with geologist: - (y/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />