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MONITORING WELL INSTALLATION REPORT <br /> Date:_ <br /> rT CONSTRUCTION <br /> Premise Address: <br /> Total Depth_ f �, <br /> Well No.: M 6./ _ Screen Length (from) (to) <br /> Fillet Pack 4- (from)—(to) <br /> Inspector. yafts, Bentonite' (from) (to) 2 <br /> Grout (from __� (to) <br /> Permit No. �oC(�ys Drilling rig type <br /> Auger O.D. I <br /> Drilling Company: VxV vue , �-'y Completion - Stove pip Christie bo (circle one) <br /> Driller: <br /> TT casing <br /> Consultant A-L'54rL) — 577AFNr-c- e height <br /> Geologist JWFJ (KTYJ <br /> ABOVE-GROUND <br /> cONPLEIION CHRISFN4CX <br /> SPECIAL PERMIT INFO, COMPLETION <br /> Ground Surface <br /> Distance to sewer line <br /> Domestic well on site Ty/n) Grout <br /> If yes, location and distance <br /> is rt. <br /> SAMPLING : - <br /> ala ttad - — c <br /> Holding Temperature an x 9 <br /> Method _ gnvs?Pack <br /> Screening Method <br /> Tracking Sheet (y/n) c . <br /> tt- <br /> SPOILS <br /> Storage Method MATERL9LS/DEVELOPNM <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type Zn Ue <br /> Blank 32�/c ft. Screen /%- ft• <br /> GROUTING Slot size_ D.azn <br /> Bags cement °I F}AaS/qy rs <br /> Depth to water Buckets bentonite / <br /> Mix Ratios Bags sand/gravel_ q <br /> Installation Method Filter Pack typesize ? /L <br /> Quantify Installed .....- <br /> Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method <br />