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' MONITORING WELL INSTALLATION REPT <br /> Date: ��' ��� l I CONSTRUCTION <br /> Premise Address:— T 111 Total Depth <br /> Screen Length (from) (to) <br /> SE— <br /> Well No.: Filter Pack (from) (to) -7-j <br /> Bentonite (from) (to) i 'l <br /> Inspector. A)-"i Grout (from) I (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. :1 I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: 01 <br /> Driller: �2E J�� casing <br /> height <br /> Consultant 1' <br /> T <br /> Geologist •- <br /> ABOVE-GACUND <br /> COMPLETION <br /> &CO <br /> SPECIAL PERMIT INFO. Ground Surfacs <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - (y <br /> If yes, location and distance ft. <br /> ft. <br /> SAMPLING slorled — <br /> secicn <br /> Holding Temperature_ <br /> Method -lb 144 - _ <br /> Screening Method <br /> Tracking Sheet <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted ( / n I <br /> Storage Location Fc, 1 Casing type Q It 7 Ctl AD <br /> Blank ft. Screen 2d2 ft. <br /> Slot size • DID <br /> GROUTING I Bags cement <br /> P �� �� Bu�kets c Hite <br /> Depth to water /L Bas a ,ravel <br /> Mix Ratios Filtc type/size <br /> Ali-7— <br /> Installation Method 1 Surge Block: - ( y/ <br /> Quantity Installed Discussed with geo gist: - / n ) <br /> Type of method <br /> EH 29 29 <br />