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MONITORING WELL INSTALLATION REPORT <br /> Date:— CONSTRUCTION �C JU 1 I ' <br /> la` <br /> Premise Address: 9' o 0 V Total Depth Lj <br /> /� GScreen Length (from) -4 ir.. (to) <br /> Well No.: / Filter Pack (from) (to) `7 <br /> Bentonite (from) (to) ,SSj <br /> Inspector: a Grout (from) (to) <br /> C Drilling rig type J _ <br /> Permit No. Auger O.D. p I.D. 1W_ <br /> 1 �j�� Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:_ <br /> Driller: ! casing <br /> C <br /> Consultant height _ <br /> Geologist � 1A�A y-- <br /> ABOVE-GROUND <br /> COMPLETION CtiAl5T1 80X <br /> COMPI E71ON <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - <br /> b ft. ft. <br /> m <br /> A <br /> _ <br /> SAMPLING <br /> slotted <br /> sae9on <br /> B <br /> Holding Temperature <br /> Method _ graHsl Pack <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type C V <br /> Blank (4(7 ft. Screen i U ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <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 />