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MONLTORING WELL INSTP11ATION RFPORT <br /> CONSIRUC;'RON <br /> Date: <br /> Premise Address: ! O . Total Depth <br /> Screen Length (from) (Eo) <br /> Wel! Na.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> _ — Groue <br /> Inspector (from) {to) <br /> Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller• _ height <br /> Consultant - <br /> A_PC YE-G R CLJN D Ck R:M_;_JX <br /> coher'LEF GN Cl .'?L_i1GN <br /> scs <br /> SPECIAL.PGRMYT INFO. Cxa:nd Sul <br /> qta.: <br /> Distance to sewer line <br /> Dome'sdc well on site .- ( y/ n ) Lt <br /> if yes, location and distance - ' <br /> fit. L <br /> a <br /> ilaC� J, c <br /> SAMPLING 2RC7Cil - <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - {y/ n) <br /> SPOILS <br /> MATERIALS EV£LOPMEN'C <br /> Storage Method <br /> Contarntnation Noted - (Y n) g e <br /> Casin typ f <br /> Storage Location Blank fr. Screen <br /> Slot 51z-- <br /> Bags <br /> izeBags cement <br /> GROUi•{NG Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pack type/size <br /> Mig Ratios Surge Block: - (Y n J <br /> jAstallation Method Discussed vith geologist: - (y/ n) <br /> Quantity Installed Type of method <br /> RH 29 29- <br />