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- MONITORING WELL INSTALLATION REPORT <br /> J <br /> Date:_ S 12�l .i D CONSI-RU=ON <br /> Premise Address: Total Depth S S <br /> Screen Length (from) .35- " (co) <br /> Well No.: <br /> Filer Pack (from). 3Z . (to)_�S' <br /> Bentonite (from) <br /> Inspector. . .. Grout (from)_! <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/clu-istie box (circle one) <br /> Drilling Company-., Wong c.Jou.. <br /> Driller <br /> . casing. <br /> height <br /> Consultant C <br /> \ '�• <br /> Geologist_ (Alk^ <br /> A-AYE-G FI CUN D C�R:STY$OX <br /> CQtrSr'1ETKI t� Gpfi{P,:-TION <br /> SPECIAL PERMIT INFO. g <br /> Distance to sewer line prx <br /> Dpmesdc..well on site- (y <br /> If yes, location and dis e - <br /> J t; <br /> SAMPLING -- o <br /> Holding Temperature, <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/.n <br /> SPOILS r <br /> Storage Method -i MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) - <br /> Storage Location Casing type Z PyC <br /> • - Blank' 3 S fc Screen a0 fr. <br /> _ Slot size. <br /> GROUTING ,', ` Bags cement <br /> Buckets bentonite <br /> Depth to water - Y Bags sand/gravel <br /> Mix Rados Filter.Pack-type/size <br /> installation Method Surge Block: (y <br /> Quantity Installed . Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29. . <br /> f <br /> Na <br />