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MONITORING WELL INSTALLATION REPORT <br /> Date: J? 01 CONSTRUCTION <br /> � 3 , W • <br /> Premise Address:] zi mil. Total Depth �Z <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 /> Drilling Company: EST <br /> Completion - Stove pipe/dui tie box (cirde one) <br /> - L , <br /> Driller: casing, <br /> T height <br /> ConsultagLIn IV <br /> Geologist <br /> • ABOVE-GFlCUND —WT <br /> W MPL_E'DON Cl-nZTY•Box <br /> SPECIAL PERMIT INFO. gu{xy <br /> Distance to sewer line tlra'" <br /> Domestic well on site- (y/n) ft <br /> If yes, location and distance - <br /> i <br /> h. t. <br /> i; z <br /> SAMPLING — <br /> r/b socicn �= <br /> Holding Temperature 7 — <br /> Method_f '= <br /> Screenin;Me d rWD <br /> Tracking Sheet - (y/0 <br /> SPOILS 7, <br /> / f <br /> Storage Method N✓1 MATERIALS/DEVE[,OPMENT <br /> Contamination Noted - (y 49 <br /> Storage Location Casing type <br /> Blank ft Screen h• <br /> Slot size <br /> GROUTING Bags cement f <br /> Buckets bc*nite <br /> Depth to wate�/ . 1 Bags sand/gsavel <br /> Miz Ratios AA oo Filter Pack type/size <br /> installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />