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MONITORING WELL INSTALLATION REPORT <br /> Date:- C�/G�t CONSTRUCTION <br /> (/ t <br /> Premise Address: �l7 t^i �i�7t;:� G� Total Depth <br /> ��� Screen Length (from) (to)_ <br /> Well No.: Filter Pack (from) <br /> (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: <br /> casing <br /> / height <br /> Consultant L7��-t� ���''-L <br /> Geologist ,_ <br /> ABOVE-GROUND <br /> COWFLET;ON CHRJM-60X <br /> SPECIAL PERMIT INFO. COMPLE71CN <br /> Ground Surfxa <br /> Distance to sewer line trout <br /> Domestic well on site - (y/n ) ft <br /> If yes, location and distance - <br /> n �. <br /> µ' C <br /> SAMPLING slatted <br /> Holding Tem erature <br /> Method <br /> Screening Method <L i.j.aajn j2k <br /> Tracking Sheet (y/ n ) <br /> SPOILS <br /> Storage Method gc-lwjMATERIALS/DEVELOPMENT <br /> Contamination Noted - r y/ n ) /$ <br /> Storage Location Casing type t�t(c <br /> Blank ft. Screen <br /> Slot size 0-a4)c-) <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 />