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VONITORING WELL INSTALLATION REPO`k-e <br /> Date: I a` 10 o CONSTRUCTION <br /> Premise Address: Total Depth <br /> ,/'� Screen Length (from) S (to) �7 <br /> Well No.: f � a" Filter Pack (from) 3 (to) <br /> � ,. Bentonite (from) P- (to) 3 <br /> Inspector: Grout (from) (to) v <br /> // Drilling rig type _ �g <br /> Permit No. 00 '�- y 7 to Auger O.D. <br /> t Completion - Stove pipe/ tristie box (circle one) <br /> Drilling Company: W MAS <br /> Driller: casing <br /> height <br /> Consultant_ I <br /> —qVT <br /> Geologist -- <br /> AaOVE-GRCUND CNAISTY-80X <br /> COMPLETION COMPLEMN <br /> SPECIAL PERMIT INFO. Ground Surfacs <br /> Distance to sewer line grout <br /> Domestic well on site - n ) �' 2 ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> w <br /> SAMPLING doral <br /> sucicn <br /> Holding Temperature. <br /> RaV�I pack <br /> Method � _ <br /> Screening Method _ <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n f, p <br /> Storage Location 6— � Casing type <br /> Blank S fL Screen <br /> Slot size <br /> GROUPING 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/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />