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MONITORING WELL INSTALLATION REPORT <br /> • /A0 <br /> Date: *4Lq <br /> CONSTRUCTION <br /> Premise Address: Total Deprh 35 <br /> Well No.: Screen Length (from) (to) <br /> Finer Pack (from) 3 (to) <br /> Inspector: Bentonite (from) <br /> (to) <br /> Grout (from) '] (to) � <br /> Permit No. 3 F( Drilling rig type Gz' <br /> ---� Auger O.D. <br /> Drilling Company: Completion - Stove pipe (circle one) <br /> Driller: <br /> casing . <br /> Consultant- Qy- - height . <br /> Geologist <br /> AP.O VES�CtfN� <br /> CC)YPLETQN cuOiSiY-BOX <br /> SPECIAL PERMIT INFO CCMPL MN <br /> -- GI StI <br /> Distance to sewer line grCut <br /> Domestic well on site - {y <br /> If yes, location and distance <br /> -Z — _ a <br /> w <br /> C <br /> SAMPLI IVIG o <br /> Holding Temperature r <br /> Method - �raYnt Paas <br /> Screening Method =► <br /> Tracking Shcet (y/ n) . <br /> �. -ft. <br /> SPOILS <br /> Storage Method MATEPJ�EV_EI.OPMENC <br /> Contamination Noted - {y/ <br /> Storage Location Casing type �- V <br /> Blank LO ft. Screen__ s fr. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Buckets <br /> sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> installation Method Surge Block: - (y/n ) <br /> Quantity Installed Discussed vrith geologist: - (y/ n) <br /> EH 29 29. - <br /> Type of nediod <br />