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MONITORING WELL INSTALLATION REI'�T <br /> Date: -7111/,9 CONS ON <br /> Premise Address: v / b"'u'�, Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> t L Bentonite (from) (to) <br /> Inspector: l�fGrout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion -Stove pipe/cluistie box (circle one) <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist <br /> ABOVE-GACUND <br /> COMPLETION Ci�itSTY-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Swfacs <br /> Distance to sewer line Ori <br /> Domestic well on site - (y/n) _ft. <br /> If yes, location and distance - M <br /> SAMPLING <br /> tecicn <br /> Holding Temperature <br /> Method ' = R"/°I pack <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> ft. = tL <br /> SPOILS <br /> Storage Method, MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type <br /> Blank 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 /> EH 29 29 Type of method <br />