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MONITORING WELL.INSTALLATION REPORT <br /> Date:_ <br /> CONSTRUCT7pN <br /> Premise Address:��3�� � �f � � <br /> Total Depth <br /> Well No.: / Screen Length (from) (to) <br /> Filter Pack (from) (to) _ <br /> Inspector. _ t_2)i A A�r r» , Bentonite (from) <br /> Grout _�� (to) 1 <br /> ----- . (from) <br /> hermit No. 3 S Drilling rig type <br /> Auger O.D. i.D. <br /> Drilling Company; e Completion - Stove pipe/cli isde box <br /> (circle one) <br /> DrilIer._ <br /> Y_ casing <br /> Consultant height <br /> Geologist _WT <br /> APCVE-GRCUND <br /> SPECIAL, PERMIT INFO. Ct�h�L'�T10N C-�*—ry-30X <br /> Grvc:nd 5uiacy SPL_-nCN <br /> Distance to :ewer line <br /> Domestic well on site - ( grout <br /> If yes, location an tante - <br /> f t. <br /> r <br /> SA'4TPL1yG - — <br /> Holding Temperature soden <br /> Method b a <br /> Screening Method - P-1 Vol <br /> Tracking Sheet -(y/ n ) <br /> Storage Method . <br /> Contamination Noted - C y/n ret* ! MATERIALS EVELOPMENT <br /> Storage Location <br /> Y Casing type C <br /> Blank O fr. Screen_ / S <br /> C� Slot size fr' <br /> Bags cement <br /> Depth,to water 1%J Buckets bentonite ti <br /> Mix Rados Bags sand/gravel n) <br /> lnsta]IztionN <br /> Method �� Filter Pack typejsize �-- <br /> QUantity InsralIcd Surge Block: _ (y <br /> Discussed with geologisr: - (y C� <br /> EH 29 29 Type of Method LJ <br />