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i <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: <<(! 6IgV\ CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to)-6 <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig <br /> Permit No, Auger O.D. typ It I.D. <br /> Drilling Company: Completion - Stove pipe/cliristie box (circle one) <br /> Driller: casing <br /> height <br /> Consultant b� 4 <br /> Geologist <br /> ABCVE-GACUND <br /> COMPLETION C148z Y-BOX <br /> SPECIAL PERMIT INFO. G=rd gay <br /> COMPLETION <br /> Distance to sewer line gran <br /> Domestic well on site - (y/ n ) 0 <br /> If yes, location and distance - ft, <br /> (p <br /> a° <br /> — m <br /> SAMPLING sicrAi _ s <br /> socIcn '- <br /> Holding Temperature =_ <br /> Method —_ g"YYI Pack <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> —3—0 — Lzo = s ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Locationp� Casing type 2281C/ <br /> * la Blank (Q h. Screen Z b ft. <br /> Slot size O.OtO <br /> GROUTING oto <br /> (�D L Bags cement <br /> ( * aZQor °� ZO � ° Buckets bentonite <br /> Depth water 42 U Bags sand/gravel I p O <br /> Mix Ratios Filter Pack type/ ize <br /> Installation Method Surge Block: - n ) <br /> Quantity Installed Discussed with logist: - n ) <br /> EH 29 29 Type of method lJ <br />