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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth T <br /> Screen Length (from)' 2 (to) <br /> Well No.: Filtet Pack (from) 2 (to) -3spr <br /> Inspector: . J•`fIBi +12— Bentonite' (from) !9 f (to) 2z Fr <br /> Grout (from) O (to) fq?f-r <br /> Drilling rig type ,M: 1 Rctx ,- <br /> a <br /> Permit No. Auger O.D. h <br /> Completion towe pi e�•' tie box (circle one) <br /> Drilling ComPanY���•4 �¢i LL �me <br /> Driller: (12-1 S ST P► g eg 3� <br /> casing <br /> height <br /> Consultant c L 2S <br /> Geologist As-rt4 la g n(a" _ <br /> ABOVE-GROUND <br /> COMPLETION CNAISN BOX <br /> SPECIAL PERMIT INFO. Ground3urlxo COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - ft• <br /> ft. ft. <br /> x>; <br /> vi = m <br /> — e <br /> SAMPLING <br /> Holding Temperature <br /> Method " <br /> Screening Method — <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method MATERLSLS/DEUELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type al Scl. SO QVC <br /> Blank "31 ft. Screen as ft. <br /> GRdUTING Slot size 0.O ZO <br /> Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 4S o <br /> Mix Ratios Filter Pack type/size da' 3 S" <br /> Installation Method <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> EH 29 29 Type of method <br />