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J � <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: 141<146 CONSTRUCTION <br /> Premise Address: �� l�-t&2. !iL¢¢ YJ Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. ( Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> FAA-) he_ght <br /> Consultant <br /> GeologistQiIJ h� C�t�l l �0��8 S�( - (,�b� <br /> ABOVE-GACUNO C>�itSTY30X <br /> COl SPLETiON CCMPLEMCN <br /> SPECIAL PERMIT INFO. Ground Suian <br /> Distance to server line <br /> prwt <br /> Domestic well on site - ( y/ n ) ^tt <br /> If yes, location and distance - <br /> ft. <br /> n. <br /> = m <br /> p <br /> - O <br /> C <br /> SAMPLING dorwi <br /> s 'cn _ <br /> Holding Te;lpPerasure `( <br /> Method tS/t,4M 7 = ffiv�F <br /> a <br /> Screening Method <br /> Tracking Sheet - n ) <br /> ft. = qrft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type _ <br /> Blank ft. Screen fc. <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/ ii ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />