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MONITORING WELL INSTALLATION REP <br /> Date: -2,' Y CONSTRUCTION <br /> Premise Address: 7 rr-�� &-'-c P4�2 Total Depth <br /> Well No.: �� ' X Screen Length (from) (to) <br /> 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 /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> A. <br /> Hriher<L Z,- C�cas inq <br /> Consultant i height <br /> Geologist ' <br /> ABOVE-GROUND <br /> COMPLE CN CHRZTY43OX <br /> SPECIAL PERMIT INFO. COMPLEnON <br /> Ground Suriacs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - alt, <br /> SAMPLING — s <br /> slotted _ 6 <br /> aacoon — <br /> Holding Temperature _ gr&�W p <br /> ack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <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 /> i Buckets bentonite <br /> Depth to water (i Bags sand/graveI <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 />