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MONITORING WELL INSTALLATION REPORT <br /> 'n <br /> Date: CONSTRUCTION <br /> Premise Address: 9�V6 Gyl '`'` ' I Total Depth <br /> Screen Length (from) (to) <br /> Well No.:_ "� / jaw �✓l%�l/ 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 /> Consultant a!%,�,n,(' t,.c,r3 7 <br /> + <br /> Geologist ._ <br /> ASOVE-GROUND <br /> OOPPLETION CHRIST 4= <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground S„-izs <br /> Distance to sewer line P� <br /> Domestic well on site - (y/n ) ft <br /> If yes, location and distance - <br /> ft. <br /> ft. <br /> a <br /> = o <br /> C <br /> SAMPLING ° <br /> flatted c <br /> tat5on — � <br /> Holding Temperature A_1A <br /> Method Q- Pack <br /> Screening Method = <br /> :C <br /> Tracking Sheet - (y/ n ) <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) t3'P <br /> Storage Location Casinge t (. <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUPING Bags cement <br /> Buckets bentonite <br /> Depth to water lG 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 />