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MONITORING WELL INSTALLATION REPORT <br /> Date: 'a CONSTRUCTION <br /> Premise Address: We Total Depth__2 2- <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) 33, (to) !z <br /> Bentonite (from) j Z(from) (to) <br /> --(to) <br /> Inspector: l�( �l� Grout r !l � u' ' <br /> Drilling rig e - <br /> Permit No. Auger O.D. `� I.D.— <br /> Completion - Stove pip -tie box ircle one) <br /> Drilling Company: sr' im'— <br /> Driller• <br /> f casing <br /> height <br /> Consultant T <br /> � � T <br /> Geologist ABOVE-GRCUND <br /> COMP1.ETfON Ct��Tf-BOX <br /> coMPLEMN <br /> SPECIAL PERMIT INFO. Ground <br /> Qrcut <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) f it. <br /> If yes, location and distance - ,,l!11fL <br /> +Y <br /> — a <br /> SAMPLING s1cr&d — <br /> soctcri — <br /> Holding Temperature �- -_; = 71 P-xic <br /> Method — <br /> Screening Method s <br /> Tracking Shcet (y/ nIF <br /> ) r . <br /> SPOILS <br /> Storage Method oar [, MATERIALS EVELOPMENT <br /> Contamination Note - ( y <br /> Storage Location -*X4 Casing type <br /> Bl Screen fr• <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Z`i Bags sand/gravel 2 -2 5�1�►c <br /> Mix Ratios Filter Pack type/size <br /> Installation Metho(f Surge Block. -Cp n ) <br /> Quantity Installed Discussed with geologist: - O n ) <br /> Type of method <br /> EH 29 29 <br />