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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address:of y1 Y2" �iva Total Depth <br /> Screen Length (from) (to)__ <br /> Well No.: Filter Pack (from) (to)__ <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company:_ c1 <br /> Driller: —�-• casing <br /> height ' <br /> Consultant_5 <br /> Geologist2 S (! 0 3) q 7S– - G8�S� T <br /> AE&E-GROUND CHAfSTY-80X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line Cfout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - <br /> ft. ft. <br /> CD <br /> SAMPLING = s <br /> totted <br /> aecdon <br /> Holding Temperature <br /> ack <br /> Method ` __ 7"�t <br /> Screening Method <br /> Tracking Sheet - (y/n ) 2k, <br /> 4. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <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/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />