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MONITORING WELL INSI•ALLXTION REPORT <br /> i�hJ <br /> CONSTRUCTION <br /> Date:_. <br /> y Sr Total Depth 2s <br /> Premise Address: / i4 Screen Length (from) (CO) <br /> a '' Filter Pack (from) Z l9 ' �(to) <br /> Well No.: �� �,C' Bentonite (from) /7 /9 (CO) <br /> � I� Grout (from) 7-- / 7 (to) <br /> Inspector. Drilling rig type f-- A.1- <br /> Auger O.D. I.D. <br /> Permit No. 1 1 Completion - Stove pioe/ch-ristie box (circle one) <br /> Drilling Company: woad o-4// <br /> .' T casing <br /> Driller , he'_ght <br /> Consultan <br /> ` }?AYE'.-G F CUN D <br /> u <br /> Geologist 'f�" CCN LETpON CIO,,P�cN <br /> Cxx;•d S�zixa <br /> SPECIAL PERMIT INFO• prcut <br /> Distance to sewer linef;. <br /> Domestic welt on site .- (y/ n) ft. <br /> If yes, locaticn and distance - <br /> � M <br /> L) S� <br /> SAMPLING <br /> Holding Temperature <br /> Method — <br /> Screenin;Method : <br /> Tracking Sheet - (y/ n} _ ft. <br /> tt. <br /> SPOILS <br /> M ATERI ALS/DEVELOP VENT <br /> Storage Method 1 /' rV G <br /> Contamination Noted - (y/ n) Casing type <br /> Storage Location Blank------ft; Screen <br /> Slot size <br /> Bags cement <br /> GROUnNC- Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pack type/size <br /> Mid Rados Surge Block: - (y/ n} <br /> 4pstalladon Method Discussed with geologist: - (y/ n <br /> Quantity Installed Type of rncdiod <br /> EH 29 29• <br />