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MONITORING WELL INSTALLATION REPORT <br /> Date:— ZZ 7 CONSTRUCTION <br /> t <br /> Premise Address:_S113 F / </ Total Depth <br /> L Screen Length (from) (to) <br /> Well No.: Filter Pack (from)—(to)— <br /> Bentonite <br /> from) (to)Bentonite (from)—(to)— <br /> Inspector: <br /> from) (to)Inspector: [d – Grout (from)—(to)— <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. S K G P ) Auger O.D. I.D. <br /> Drilling <br /> Completion- Stove pipe/christie box (circle one) <br /> Company: �d'4 <br /> Driller: casing <br /> height <br /> Consultant A-`-� <br /> Geologist &", <br /> ABOVE-GROUND CNA1577 BOX <br /> COM?LETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Suriacs <br /> Distance to sewer line Grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - ft' <br /> ft. <br /> n. <br /> _ <br /> = P <br /> P <br /> C <br /> SAMPLING — <br /> alattad <br /> HoldingTet pgrature�t� _ � PackP <br /> Method T"tom LJ — <br /> Screening Method <br /> Tracking Sheet - (/y) n4.) <br /> SPOILS <br /> Storage Method IUA MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/0) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to waterV�fl Bags sand/gravel <br /> Mix Ratios ci Filter Pack type/size <br /> Installation Method Surge Block: (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />