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MONITORING WELL INSTALLATION REPORT <br /> Date: 6 o-6 CONSTRUCTION <br /> Premise Address: 3 4C S- Total Depth <br /> Screen Length (from) (to) <br /> Well No.: 1M ln1 - ?, yin(�-� Filter Pack (from) (to) <br /> T Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. - Auger O.D. I.D. r <br /> ' �`• Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: ' <br /> Driller: + <br /> casing <br /> r height - <br /> Consultant <br /> Geologist ._ <br /> ABOVE-GROUND C}iFiJSTY 80X. <br /> COMPLETION <br /> �t COMPLETION <br /> SPECIAL PERMIT INFO. Qround'Su Imo. <br /> Distance to sewer line Grp <br /> Domestic well on site - (y/n ) <br /> u,If yes, location_ and.distance - r ft. <br /> .. .ft. ft. <br /> C <br /> SAMPLING = <br /> aIcttad — c <br /> > &#Cton <br /> Holding Temperature — <br /> Method "'w <br /> Pack <br /> Screening MethodJ. <br /> Tracking Sheet - (y/n ) — <br /> k a i ' 4 - �ift• � ! � - <br /> S /' ft• <br /> SPOILS r <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/-n ) <br /> Storage,Location Casing type__ 2- <br /> Blank ;�_ft. Screen <br /> Slot <br /> GROUTING • Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel ` <br /> Mix Ratios Filter Pack type/size z _ <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of'Method <br /> EH 29 29 <br />