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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: 16 L orn W Total Depth LtO <br /> Screen Length (from) Lo ,(to) yv` <br /> Well No.: Filter Pack (from) ISS (to)— 40 <br /> Bentonite (from) (to) 1 <br /> Inspector: Grout (from) (to)__146 - <br /> Drilling rig type <br /> Permit No. S 3 n `� Auger O.D. I.D. <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: , <br /> Driller: casing <br /> height <br /> Consultant { 4:]tnZL==3 _ <br /> Geologist <br /> ABOVS-GROUND CHRLM 3OX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. tend Surface <br /> Distance to sewer line grout <br /> Domestic well on sit y/ n <br /> If yes, location distance - . <br /> a <br /> y; b <br /> O <br /> k` C <br /> O <br /> SAMPLING slattedr — <br /> t�caan � <br /> Holding Temperature <br /> Method P <br /> Screening Method <br /> Tracking Sheet - { y/ n ) <br /> $a A. tt. <br /> SPOILS <br /> Storage Method `' 5-2gp-_� r.��. MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y AD1 <br /> Storage Location Casing type -2— <br /> Blank <br /> Blank a O ft. Screen a-f7 ft. <br /> Slot size <br /> GROUPING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel -�- <br /> Mix patios 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 /> rte^ � <br />