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-� <br /> MONITORING WELL INSTALLATION REP xT <br /> Date:AAd <br /> � CONSTRUCTION <br /> Premss: 0 Total Depth <br /> Screen Length (from) (to) <br /> Well No.: AA� y ^ 1 Filter Pack (from) (to) <br /> 1 ^ Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. M.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company= p <br /> casing <br /> height <br /> Consultant <br /> �� <br /> CRsi ��PLETICNO _ <br /> GeolcgisrC ��f �J� a t1 <br /> ABCVCHRM4 30x <br /> Cti^f.f�I�TKJN COW l-i ICN <br /> SPECIAL PERMIT INFO. Ground Slxf � <br /> I <br /> Distance to sewer line PIZ <br /> grout <br /> Domestic well on site - ( y / n ) �_ t- <br /> If yes, location and distance <br /> SAMPLING �baad <br /> Holdin T pp,e�Cure I _ ,carol pads <br /> ,MethodU/# <br /> Screening Method <br /> Tracking Sheet - / n ) _— <br /> iL = tL <br /> SPOILS <br /> Storage Method /lt -S � MATERIALS/DEVELOPMENT <br /> Conraminadon Noted - 0/ n i/ w <br /> Storage Location /J�A Casing typet? <br /> Blank fc Screen <br /> Slot size <br /> GROLMNG Bags cement <br /> Buckets bentonite <br /> Depth to waterBags sand/grave! <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block_ - ( y / n ) <br /> Quantity Installed Discussed with geologist - ( y / a ) <br /> Type of merhod <br /> EH 29 29 <br />