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o • 0 <br /> MONITORING WELL INSTALLATION REPORT <br /> �O S1 <br /> Date: '�I'*Iqcl <br /> CONSTRUCTION <br /> Premise Address: 7 iv Total DepthLb— <br /> U <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> J� <br /> j Bentonite (from) (to) <br /> Inspector: iz Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> ��� height <br /> Consultant 'r '4 <br /> Geologist T <br /> ABOVE-GRCUND CNAJSTY 80X <br /> COMPLETbN CCMPL_TICN <br /> MI <br /> SPECIAL PERT INFO. Ground SU f <br /> Distance to sewer line gran <br /> Domestic well on site - (y/ n) ft, <br /> If yes, location and distance <br /> R. <br /> = m <br /> SAMPLING = <br /> sloned _ <br /> tacien - — <br /> Holding Temperature <br /> Method = R'Yd Pack <br /> Screening Method <br /> Tracking Shcet - (y/ n ) <br /> K• — ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/grivel <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 />