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MONITORING WELL INSTALLATION REPORT <br /> Date:�� ��! D7, �. CONSTRUCTION <br /> Premise Address:� Total Depth <br /> Screen Length.(frorn)' (to) <br /> Well No.: 6 'Z� �Z2� - Filte-Pack (from) (to) <br /> J , ` Bentonite (fro (to) <br /> Inspector: Grout (fro ) (to) <br /> Drilling rig type <br /> Permit No.� � �_ _ -Auger O.D. I.D. <br /> Completion.- Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller_,''' 6 _ casing - <br /> - height <br /> Consultant <br /> Geologist L •r <br /> ABO -G A CHR - <br /> BOX , <br /> CO )ON C L€n.CN <br /> SPECIAL PERMIT INFO. &dacl . <br /> Distance to sewer line pr <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - . <br /> m <br /> e� e <br /> a; o <br /> • O <br /> SAMPLING slotiad :1 <br /> Holding Temerature `7 Bacon — FAW Pack <br /> Methods <br /> Screening Method <br /> Tracking Sheet -g/ n ) <br /> .a. <br /> SPOILS <br /> Storage Method TERIALS EVELOPMENT <br /> Contamination Noted - (y/ n } - <br /> Storage Location Cas type <br /> Blank ft- reen ft. <br /> Slot siz <br /> GRODUING Bags c nt <br /> r Buckets b tonite <br /> Depth to water 216Bagssand/ vel <br /> Mix Ratios/In Filter Pack a/s' e <br /> Installation Method "` Surge Block: - / n ) <br /> Quantity Installed Discussed wi eologist: - {y/ n ) <br /> Type of meth d <br /> EH 29 29 <br />