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i <br /> I 1A - , <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: (( CONSTRUCTION <br /> Premise Address: 84 bG L &4-A�L l jo; Total Depth <br /> Screen Length (from) (to) <br /> Well No, : Ai / U 1 - 7 Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: .y� Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. LD. . <br /> Company:- <br /> �z / Completion - Stove pipe/christie box (circle one) <br /> - <br /> Driller: TT casing <br /> height <br /> Consultant (CR4 <br /> Geologist Jo lh« FnMo T <br /> ✓/J ASOVE-GFOUND CHAISTY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground g�xa COMPLETION <br /> Distance to sewer line 7rOut <br /> Domestic well on site - ( y / n ) <br /> If yes, location and distance - n <br /> n. <br /> SAMPLING <br /> slotted <br /> taction x <br /> Holding Temperature.D <br /> Method 'Al = r P <br /> Screening Method <br /> . = .. ' <br /> Comes <br /> somme <br /> Tracking Sheet - ( y / n ) _ <br /> n. = n. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) <br /> Storage Location Casing type d '11°O[i <br /> — <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> rBuckets bentonite <br /> Depth to water 2 Bags sand/gravel <br /> Mix Ratios Filter Pack typesize <br /> Installation Method Surge Block: - ( y / n ) <br /> Quantity Installed Discussed with geologist: - ( y / n ) <br /> EH 29 29 Type of method <br />