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MONITORING WELL INSTALLATION REPf'n: <br /> Date: %/(I /� CONSTRUCTION <br /> Premise Addressa' I T 4 G CAiy1 , I, Total Depth r iz <br /> /# Screen Length (from) (to) <br /> Well No.: /� �✓ ' Filter Pack (from) I (to) <br /> �� Bentonite (from) (to) <br /> Inspector: /d Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> o Completion - Stove p pe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> /h height <br /> Consultant(! �j/�-( <br /> Geologist �%1'nnn <br /> ABOVE-GROUND _ <br /> OONFLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Su tacr <br /> Distance to sever line grout <br /> Domestic we on site - (y/ n) <br /> If yes, locati�n and distance - —n ft. 4 <br /> _ <br /> SAMPLING slotted <br /> secion =_ <br /> Holding Te perature <br /> Method = P <br /> ack <br /> Screening ethod N <br /> Tracking heet - (y/ n ) <br /> I tL <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) 'I <br /> Storage Location Casing type I U( Sc�yG <br /> Blank J - ,�ft. Screen Za h. <br /> Slot size o•(1l D <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> InstalYation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />