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IONITORING WELL INSTALLATION REPt <br /> Date: ff CONSTRUCTION <br /> Premise Address:-- `f � �'� Total Depth ' <br /> Screen Length (from) a (to) S <br /> Well No.: Filter Pack (from) (to) 3'_ <br /> Bentonite (from) '(to) / <br /> Inspector: Grout (from) (to)�� <br /> Drilling rig type h .e yvjj <br /> Permit No. Auger O.D. <br /> 1 Completion - Stove pip iristie bo ircle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant v� <br /> Geologist -- <br /> ABOVE-GACUND q-MM-aOX <br /> COMPLEr)ON CCMPL_mON <br /> SPECIAL PERMIT INFO. Grourd SLrfacR <br /> Distance to setter line grout <br /> Domestic well on site - (y rn ft. <br /> If yes, location and distant ft. <br /> M <br /> - O <br /> SAMPLING doral = c <br /> sacicn <br /> Holding Temperatlire <br /> Method /ca--- .r. <br /> Screenin;Method 11 <br /> Wracking Shcet - C y/ n ) <br /> SPOILS <br /> Storage Method ^'� MATERIALS/DEVELOPMENT <br /> Contamination Noted - n) <br /> Storage Location Casing type <br /> Blank e S fL Screen . rfU ft. <br /> Slot size GROUTING Bags cement <br /> Buckets bentonite r <br /> Depth to wTater �.y Bags sand/gravel <br /> Mix Ratios Filter Pack type/size :S <br /> Installation Method Surge. Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />