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MONITORING WELL INSTALLATION.REPORT <br /> i: <br /> Date: I CONSTRUCTION <br /> Premise Address:�Q- S_ Total:Depth .� <br /> Screen Length (from) 3 0 (to) /5} <br /> Well No.: 3 Filter Pack (from) .3� " (to) <br /> •�� p. ,Bentonite (from) /. 3 (to) <br /> Inspector. bac✓' G '" Grout`), (from) <br /> " Drilling rig•type <br /> Permit No. ?/ 7/ ' = a �' Auger-0.D. ' !Ft?# I.D. <br /> � � �, - <br /> Completion- Stove pipe/ tstie- t (circle one) <br /> Drilling Company:" � � - - � �, ". - - .` . •, � r <br /> Driller: w _ casing h <br /> Consultant� <br /> Geologist <br /> . ABOO -G L N O -�C}�ItSIY-c1QX � <br /> COWLETCN <br /> �. 4CCMPLEnON <br /> SPECIAL PERMIT INFO. { C rind SWwo S <br /> j <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) E <br /> ' ft. <br /> If yes, location and distance - ` ft- <br /> 1 <br /> A. <br /> SAMPLINGslotted <br /> Holding Temperature V,YEW pack <br /> Method ` >>' <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y 16W <br /> Storage Location . Casing type <br /> Blank'# ` h. Screen <br /> Slot size <br /> GROUTING rt Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios _r Filter Pack type/size } <br /> Installation Method /,int _ Surge;Block: - ( y/ n } <br /> Quantity Installed ^r Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 i <br />