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MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> CONSTRUCTION <br /> Premise Address: Total Depth b 0 <br /> Screen Length (from) D (to) <br /> Well No.: ��3 Filter Pack (from) q U (to <br /> Bentonite (from) (to) <br /> Inspector. Grout (from) (to) <br /> .Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/clu•istie b e one) <br /> Drilling Company: <br /> casng <br /> Driller: tJo`^-- he'ght <br /> ' � � he <br /> Consultant <br /> GeologistA �� �� � AiGVE-GRCUND <br /> CO W LEM N Ct A.S'fY t30 <br /> COf+iPt... <br /> SPECIAL PERMIT INFO. GC°"rd Sulws <br /> praR <br /> ?� Distance to sewer line <br /> Domestic well on site . (y/n) ft. <br /> If yes, location and distance - ft- <br /> � Q <br /> SAMPLING •Iored <br /> ,� socicn � _ <br /> :r gn 14^xx <br /> Method <br /> � Holding Temperature � _ Y"", <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> (o L ft <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) Casing tY! ` L '� D <br /> Storage Location Blau ft. Screen ,-L =fr <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 5 Bags sand/gravel � --- <br /> Mix Ratios Filter Pack type/size <br /> pstallation Method Surge Block: - (y/ l <br /> Quantity Installed Discussed with geologist: - OY n) <br /> Type of method <br /> EH 29,29 <br />