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MONITORING WELL INSTALLATION REPORT <br /> Dater/G1/�, /q1.6 7 CONSTRUCTION <br /> Premise Address:. &41 Total Depth. <br /> Screen Length (from) (to) <br /> Well No, W f"td Filteir.Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. 6M SKV Auger O.D. I.D. <br /> • 0 <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:- �U�'�-sj . <br /> • i <br /> Driller: -1-Ir casing <br /> height - <br /> Consultant <br /> Geologist -- <br /> ABOVE-GROUNL? STY-805C <br /> COM LELIaN GahiPLET30N <br /> SPECIAL PERMIT INFO.a C=r)d Suri j <br /> Distance to'sewer lZ/ grout <br /> ine L <br /> Domestic well on site - n ) {t, <br /> If y6, location and dist a ti.o1 1 , <br /> f— m <br /> p <br /> �pC <br /> q"j�lJ� C <br /> fA <br /> SAMPLING 1dtSalottad <br /> &action <br /> Holding Temperature p•aCK <br /> Method <br /> •Screening Method <br /> Tracking Sheet - (y/ ri _ <br /> s <br /> SPOILS <br /> Storage Method MATERIALS EVEL�PMENT . <br /> Contamination Noted - ( y/ n ) i <br /> Storage Location Casing type_/ <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROLMNG Bags cement <br /> Buckets bentonite I <br /> Depth to water Bags sand/gra4el <br /> Mix Ratios Filter Pack ty e/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 />