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MONITORING WELL INSTALLATION REPORT <br /> Date: C7 2© /01 CONSTRUCTION <br /> Premise Address. O Total Depth <br /> Screen Length (from) (to) <br /> Well No.: VA Filter Pack (from) (to) <br /> Bentonite (from) (to)_�� <br /> Inspector, Grout (from) <br /> Drilling rig type <br /> Permit No.. . 2i",2„ ` Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/clu istie box (circle one) <br /> Driller: <br /> casing <br /> he?ght <br /> Consultant <br /> Geologist _ <br /> ABCVF--GFiCUND C ifSTY-80X <br /> OOM?t..�T�ON catisPt.,_mcN <br /> SPECIAL PERMIT INFO. G=rd Sirtacs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n } <br /> If yes, location and distance - ft. <br /> SAMPLING <br /> M <br /> sacicn .1i <br /> HoldingTemperature 'l CR. <br /> Method Fads <br /> Screening Method t ==M = <br /> Tracking Shcet - / n ) "` _ <br /> V <br /> + i. <br /> fL <br /> SPOILS <br /> Storage Method 7F` rj- \0 V-1 MATERIALS/DEVELOPMENT <br /> Contamination Noted - {y <br /> Storage Location Casing type 1, L �� <br /> Blank ft. Screen Sao ft. <br /> GROUTING Slot size . 0;T10 <br /> Bags cement <br /> Depth to wBuckets bentonite <br /> er at .t.. Z Bags sand gravel <br /> Mix Ratios Jnr Filter Pack type/size <br /> Installation t d Surge Block: - ( y�) <br /> Quantity Installed Discussed with geologist: - [ y,� <br /> EH 29 29 Type of method <br />