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1' <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: d- S C6 CONSTRUCTION <br /> Premise Address: VOLA),W• 4"� Total Depth <br /> ,, Screen Length (from) (to)__ <br /> Well No.:A4 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 /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> ConsultantJ/L� ,�-p <br /> Geologist& CY—i / D10Y V4<4-tVA,� —QW—f <br /> AE&r:-GROUND <br /> COMPLETION CHRZTY48OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sul." <br /> Distance to sewer line <br /> pram <br /> Domestic well on site - (y/ n ) ft <br /> If yes, location and distance - <br /> ft. ft. <br /> SAMPLING = <br /> alottad Y: c <br /> aacton <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet ( y/n ) <br /> SPOILS SS' <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n } <br /> Storage Location Casing typed <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 />