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MONITORING WELL INSTALLATION REPORT <br /> Date: ���' CONSTRUCTION <br /> 71b+ F Total Depth(3 <br /> Premise Address: Screen Length (from) —(to) 2l? <br /> Well No.: Filter Pack (from)—!2 k_ (to) <br /> Bentonite (from) t r (to)21 <br /> Inspector: Grout (fro ) (to)a."', <br /> , <br /> Drilling rig type <br /> Permit No. Auger O.D. /L - I.D. R <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Dcas Lng <br /> Driller: <br /> hei.gh <br /> Consultant 12 <br /> Geologist Aj0vF-4aCIJND <br /> COAFL._ETICN COMPLEEMN <br /> COMPL•.cTiCN <br /> SPECIAL PERMIT INFO. around Su•facs <br /> prat <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - 29 <br /> M <br /> SAMPLING 11orD� — <br /> socicn = � <br /> Holding Temperature _ VM 1W Pack <br /> Method — <br /> Screenin;Method = <br /> Tracking Sheet (y/ n) <br /> 74 <br /> SPOILS �Z k <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) Casing type � "NL <br /> Storage Location Blank ft. Screen 2 ft- <br /> Slot size 0-01 b — <br /> GROUTING Bags cement - <br /> Buckets bentonite — <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size �Z <br /> Installation Method Surge Block: - (p/ n ) <br /> Quantity Installed Discussed with geologist: - kly/ n) — <br /> Type of method <br /> EH 29 29 <br />