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MONITORING WELL INSTALLATION REPORT <br /> Date•, /�/� )� CONSTRUCTION <br /> Premise Address.)„Y�,q lTotal Depth <br /> Screen Length (from) (to) <br /> Well No.: dy�1/ J Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. �°''1`'"" "L Grout (from) (to) <br /> .Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pip /christie box (circle one) <br /> Drilling Company: <br /> Dtilkc: �^ casing <br /> height <br /> Consultant <br /> Geologist AV1=-GRGUNr7 <br /> W l:'PL.ET10tJ C�iR:STY-3aX <br /> COMPL�f]GN <br /> SPECIAL PERMIT INFO. Ground Sulws <br /> Distance to sewer line <br /> VT Domestic well on site - {y/n) ft. <br /> If yes, location and distance - ft. <br /> lt. <br /> N" <br /> v <br /> �i M <br /> UC <br /> SAMPLING <br /> sacicn <br /> Holding Temperature q'C/ d l-N:k <br /> Method "3' — <br /> Screening Merhod — <br /> Tracking Sheet (y/ nlift. - <br /> - tt. <br /> SPOILS <br /> Storage Method MATERIALSMEVELOPMENT <br /> Contamination Noted - (y/ n } <br /> Storage Location Casing typeft. <br /> Blankrtypsize <br /> Screen <br /> Slot s <br /> GROUTING Bags <br /> Buckit <br /> Depth to}valet _^ s�� Bags v <br /> Mix Ratios Filter /sizeinstallation MethodSurge (y/ n)Quantity Installed Discugeologist: - (y/nType d <br /> EH 29.29. <br />