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MONITORING WELL INSTALLATION REPORT <br /> IV *__4 <br /> Date yea _ CONSTRUCTION <br /> Premise Address: NO kee Aa/L Z,v, Total Depth <br /> 7 Screen Length (from) (to)- <br /> Well No.: ^��'� Filtef 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: <br /> Driller: teeing <br /> height 1 <br /> Consultant T <br /> Geologist jn._ r <br /> ABOVE-GROUND C4{F 1M_SOX <br /> COIFLETION COMPLEMN <br /> SPECIAL PERMIT INFO. Ground 5�'c <br /> Distance to sewer line 2r <br /> Domestic well on site - (y/n ) � , <br /> if yes, location and distance - ft, <br /> ft. <br /> w� a <br /> — s <br /> SAMPLING slatted :w <br /> �eL tac:ian � <br /> Holding Temperature pack <br /> Method VDA) — <br /> Screening Method�7 <br /> Tracking Sheet - n/n ) . <br /> SPOILS <br /> Storage Method MATERIALS EVELOPMENT <br /> Contamination Noted - {y/ n } Jv <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 />