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MONITORING WELL,INSTALLATION REPORT <br /> Date:_ �'�2 //� CONSTRUC I <br /> Premise Address: Total Depth 6r� <br /> Well No.:_M(rv` Screen Length (from) (to) <br /> Filter Pack (from) (to) <br /> Inspector: RKrl Bentonite' (from) (to) 3 <br /> Grout (from) Y �_(to) , <br /> Permit No. Drilling rig type f <br /> Auger O-D. <br /> Drilling Company: V41elj, ./ Completion- Stove pipe/ tie bo (circle one) <br /> Driller: <br /> casing <br /> Consultant 4-4/4P7,'D height <br /> Geologistjkh-Af-6 <br /> ASCVE-GROUND <br /> OONPLETION CI ffi m-BoX <br /> SPECIAL PERMIT INFO. COMPLETION <br /> Ciroond5urfxa <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - <br /> SAMPLING __ c <br /> Ila tted _- — c0 <br /> Holding Temperature tx7on <br /> Method — P <br /> Screening Method ^ c .• <br /> Tracking Sheet (y/n) <br /> y y <br /> ft <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type .� r /'L)d <br /> Blank_ 5 ft. Screen_ / ft, <br /> GROUTING Slot size b,UTp <br /> Bags cement /� <br /> Depth to water Buckets bentonite_ //2 6 �(W <br /> Mix Ratios Bags sand/gravel /D ,� <br /> Installation Method Filter Pack tap size <br /> ....------ --. ._ <br /> Quantity Installed Discussed with geologist: - (y/n ) <br /> EH 29 29 Type of method <br />