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1� r <br /> MONITORING WELL INSTALLATION REPOR <br /> Date: I Voln_ CONSTRUC'T'ION <br /> Premise Address: 117 � a Total Depth <br /> Screen Length (from) (to) <br /> Filter Pack (from) (to) <br /> Well No.: Bentonite (from) (to) <br /> Grout (from) (to) <br /> Inspector. Drilling rig type <br /> Permit No. <br /> Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one <br /> Drilling Company: <br /> casing <br /> Driller: F� height <br /> '9 <br /> Consultant T <br /> GeologistAi;VF--GACUND C-1_SZTY_8CX <br /> COAFLETION COMPL=–nCN <br /> SPECIAL PERMIT INFO. Ground Suiacs <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) ft• <br /> If yes, location and distance - n• <br /> —ft. <br /> z — <br /> SAMPLING <br /> sQcicn —_ <br /> Holding Temperature 73"'A tack <br /> Method = — <br /> Screenino Method <br /> Tracking Sheet - (y! n ) <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> gl ft Screen—.ft. <br /> Slot size_ <br /> GROUTING Bags cement - <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios 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 />