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MONITORING WELL INSTALLATION REPORT <br /> Y�� III3 CON�ON <br /> Date: <br /> Total Depth <br /> Premise Address: 1/0 Sn P1L Sereen Length (from) ! I (to) 3 <br /> Filter Pack (from) 14_I�_(to)� <br /> Well No.: S Z Bentonite (from) l 77.0 (to) t)S• <br /> Grout (from) •o (to) 4/•0 <br /> Inspector. Drilling rig I e <br /> Auger O.D. — <br /> Permit No. Completion - Stove pipe/cltnstie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: height <br /> Consultant R <br /> Geologist A80VE-GRCUND CHRZT1f-80X <br /> cckFLETION c*NtPI-ETICN <br /> SPECIAL PERMIT INFO. <br /> ..�Cirwrd Sala" — <br /> Ott <br /> Distance to sewer line I 4.0 • n. <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - ° n <br /> — a <br /> .torod <br /> SAMPLING socicn =_ <br /> Holding Temperature PiY�F <br /> ack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n) "• <br /> n• — n. <br /> 1. <br /> SPOILS <br /> Imo. <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type ft <br /> Blank fc Screen <br /> Slot size <br /> GROUTING 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/ it ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />