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- - MONITORING WELL INSTALLATION REPORT <br /> Date:___ S be-f 1 t a CONSTRUCTION <br /> Premise Address:_ 1 I l2- Total Depth_ s S l <br /> Screen Length (from)_ :a s5 (co)_ <br /> Well No.: 0 ` t `� � 1� Filter Pack (from) H V -T'S— <br /> Bentonite <br /> SrBentonite (from)_ _(to)_ <br /> Inspector. Grout (from)�fsy <br /> �� Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/dtristie box (circle one) r <br /> Drilling Company: rati,r'�ri <br /> Driller:_ <br /> TO u <br /> Consultant <br /> Geologist_ �tiw1 I"zrVVtd <br /> ` grout <br /> _Z jt. <br /> SPECIAL PERMIT INFO. -� seal <br /> Distance to sewer line loft <br /> Domestic well.on site .- { <br /> If yes, location and di nce - <br /> gravel pack <br /> WT <br /> ft _ a <br /> SAMPLING `3 '�- - - - <br /> �` ,seal <br /> Holding Temperature_cn,% t cwt <br /> Method <br /> Screening Method t a So ft: <br /> Tracking Sheet y n } gravel pack <br /> SPOILS <br /> Storage Method 5 J� MATERIALS/DEVE[,OPMENT <br /> Cont4mination Noted - n} <br /> Storage Location_ si'lam Casing type_ Z "eye _ <br /> Blank ft- Screen ft• <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mik Rados 62 ( Filter Pack type/size <br /> -installation Method Surge Block: - (y <br /> Quantity Installed S Discussed vrith geologist: - (y <br /> Type of method <br /> EH 29 29. . <br />