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MONITORING WELL INSTALLATION REPOnr <br /> Date: /Q/w/A CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) 5 (to) 131.0 <br /> Well No.:--A '�� Filter Pack (from) /3 (to) V� <br /> Bentonite (from) 2 (to) <br /> Inspector: Grout (from) Z (to) <br /> Drilling rig type <br /> Permit No. B S Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller &el " G&4' casing <br /> height <br /> Consultant <br /> Geologist AI&E-GR0040 <br /> OCNFLETION GkiFi15'1Y= <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line gra <br /> Domestic well on site - (y/n ) <br /> if yes, location and distance - 6 - <br /> �it. <br /> o� q <br /> — a <br /> SAMPLING Coded <br /> &scion <br /> Holding Temperaturev i? pack <br /> Method =_ <br /> Screening Method = � <br /> Tracking Sheet - (y/ n) 1 - <br /> SPOILS <br /> Storage Method 6OX 't MATERIALS EVELOPMENT <br /> Contamination No - y n Z.� <k * Q VC- <br /> Storage Location Casing type d <br /> Blank /3b ftp Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water "' Bags sand/gravel l y <br /> Mix Ratios Filter Pack type/size 3 <br /> Installation Method/ Surge Block: - (Y A0 <br /> Quantity Installed Discussed with geologist: - (y <br /> Type of method <br /> EH 29 29 <br /> i <br />