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MONITORING WELL INSTALLATION REPORT <br /> Date: °/ CONSTRUCTION <br /> Premise Address: <br /> Total Depth 1") <br /> Sween Length (from)- S (CO)29 <br /> Well No.: G�7 Filter Pack (from) 77'r (to) / <br /> Bentonite (from) is (to) <br /> Inspector. f- ^' '� Grout (from) /a —(to) <br /> ! Drilling rig �e <br /> Auger O.D. LD. <br /> Permit No. C e pipe/cluistie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: _ heigh <br /> Consultant <br /> �. w�,;.-f.� 'Geologist JlF°+OYE-GRCUND <br /> ChR;57Y-30X <br /> t;Ot�1P1._�T1CN <br /> Ground SLzf <br /> SPECIAL PERMIT INFO. <br /> grout <br /> Distance to sewer line p <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - ft• <br /> V• M <br /> - C <br /> O <br /> SAMPLING iloroi <br /> iocicn — <br /> Holding Temperature = <br /> Method <br /> Screening Method ; <br /> Tracking Sheet - (y/n) <br /> � M — <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted- (y/ n) Casing type y hind SC q <br /> Storage Location Blank A b fc. Screen­Y— ft. <br /> Slot size (I020 <br /> GROUTING. Bags cement <br /> Buckets bentonite L <br /> Depth to waterA/a ° �° Z S 6S Bags sand/gr <br /> avel <br /> Mix Ratios Filter Pack type/siz <br /> Surge Block: - (y <br /> installation Method <br /> Quantity Installed Discussed with geologist: - (n} / n) — <br /> Type of method <br /> EH 29 29 <br />