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MONITORING WELL INSTALLATION REPORT <br /> Date:idj 310 S CONSTRUCTION <br /> Premise Address:_ n �`�� l 7 � Uut Total Depth ~r10 <br /> Well No.: V P 0 f' Screen Length (from) (to) <br /> Filter Pack (from) (to) <br /> Bentonite (from)-(to)- <br /> Inspector: Y Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> �� �O,u-c, <br /> Driller: casing <br /> height <br /> Consultant 6JO&Aa-, T <br /> Geologist 5tuw _ T <br /> ABOVE-GROUND <br /> COMPLETION CHRMTY-BOX <br /> SPECIAL PERMIT INFO. GroundgUHxy COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - n- <br /> n. <br /> n. <br /> Y <br /> = t <br /> SAMPLING — � <br /> 0 <br /> slatted = $c <br /> Ip &* on <br /> Holding Temperature [ f/ <br /> Method = vs"el 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 <br /> Blank ft. Screen h. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 6�f 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 /> EH 29 29 Type of method <br />