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MONITORING WELL INSTALLATION REPORT <br /> CONSTRUC-PON <br /> Date: ` l <br /> Premise Addres �' C '" Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> / Bentonite (from) (to) <br /> Insjector. 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 /> casing <br /> Driller- � height <br /> Consultant <br /> _L � �- ABO E-G Ft CUN D Ct^nS7Y-30X <br /> COI r'1�TfON c*NtpuncN <br /> Cirour�i Sutact - - <br /> SPECIAL PERMIT INFO. _+ <br /> grout <br /> Distance to sewer line <br /> Domestic wel'. on site - (y/ ri ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> ~ O <br /> V' » <br /> - C <br /> O <br /> SAMPLINGalorRi - _ JZ <br /> sacicn <br /> .N <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> MATERIALS/DEVEI.OPMENT <br /> Storage Method <br /> Contamination Noted - (y/ n) Casing type <br /> Storage Location Blank ft Screen —�' <br /> Slot size <br /> GROUTING Bags cement _ <br /> Buckets bentonite <br /> Depth to tvater Bags sand/gravel <br /> Dep <br /> DFilter Pack type/size <br /> Mik Ratios <br /> iF►staltadon Method - Surge Block: - (y/n) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of rnctliod ---� <br /> EH 29 29. - <br />