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MONITORING WELL INSTALLATION REPORT <br /> Date: -CONSTRUCTION <br /> Premise Address: SD I� U Total Depth <br /> 99 7 Screen Length (from)' (to) <br /> `' Well No.: IJ > Filtet Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rigj <br /> Permit No. z9a� { Auger O.D. <br /> t, Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: //�� ,,,, <br /> Driller: .Mll eLIL casing <br /> r <br /> height _ <br /> Consultant <br /> Geologist (J <br /> ABOVE-GROUND CHR�STY-aox <br /> COir' LET10N COMPi,E 10N <br /> SPECIAL PERMIT INFO. Ground SurlaOR <br /> Distance to sewer line pram <br /> Domestic well on site - (y/n) <br /> r If yes, location and distance - ft, <br /> ^'r C <br /> R <br /> SAMPLING siottad :: <br /> o <br /> Holding Temperature ; ; — ': gn ew Pack <br /> Method —TF _ <br /> Screening Method rig <br /> Tracking Sheet - y/n ) — <br /> tt. — ft <br /> SPOILS <br /> Storage Method Pk MATERJALSZDEVELOPMENT <br /> Contamination Noted - (VY n ) S <br /> Storage Location Casing typ <br /> Blank ft. Screen ft• <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water �%5 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> N% Installation Method Surge Block. - (y/n ) <br /> a Quantity Installed Discussed with geologist: - (y/n ) <br /> Type of method <br /> EH 29 29 <br /> 1\ . <br />