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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> �/� � � <br /> Premise Address: � Total Depth <br /> Screen Length (from)_ 2-5-- (to) S <br /> Well No.:��!/!/ Filter Pack (from)_ (to) y <br /> Bentonite (from) y (to) Z <br /> Inspector: Grout (from) Z (to) _ <br /> `' Drilling rig type <br /> Permit No. Auger O.D. q" I.D. <br /> Completion - Stove pipe a (circle one) <br /> Drilling Company: <br /> Driller:— casing <br /> ^ � '—F height <br /> Consultant �-ii i V <br /> —W, <br /> Geologist <br /> ABOVE-GRC4JND CHRZT'Y-SOX <br /> COWP ETION Co+PLE71Cv <br /> SPECIAL PERMIT INFO. G=nd Sulact RPM <br /> Distance to sewer line pout <br /> Domestic well on site - (y/ ft. <br /> If yes, location and distance - ft- <br /> .5 ft. <br /> 'Wit y' <br /> _ a <br /> SAMPLING •lot'. _ _ <br /> sacicn _ <br /> Holding Temperature <br /> 73YW Pack <br /> Method <br /> Screening Method !% <br /> Tracking Sheet - (y/ n ) <br /> it. �.; — Z i2. <br /> SPOILS ee <br /> Storage Method -5�-� JAS ti� MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - n /n �l/C <br /> Storage Location Casing type `7 <br /> Blank ft. Screen ft. <br /> Slot size Zy <br /> GROUTING Bags cement <br /> I Buckets bentonite <br /> Depth to water � Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method ooh Surge Block: - ( y/ n ) <br /> Quantity Installed � Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />