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: 0 � <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTTON <br /> Premise Address: 37' lin>I r'et cV Total Depth �(e� <br /> / d Screen Length (from) (to) <br /> Well No.: `� Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: h41 -�� casing <br /> 7- height <br /> Consultant <br /> -_U <br /> S <br /> Geologist ABOVE GACUND <br /> CONFLE'TION U-SZ7Y-BOX <br /> comnenCN <br /> SPECIAL PERMIT INFO. .v /D rdS <br /> Distance to sewer line / � Oras <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> - — a <br /> p <br /> C <br /> SAMPLING �p�y AA-V slonai _ c <br /> if sxicn <br /> Holding Temperature AIL �r,vd F <br /> Method Al A = <br /> Screenin;Method <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> Storage Method UN 3 MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/57) o <br /> Storage Location c.- k Casing type <br /> Blank fr. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water ZZ` 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 /> Type of method <br /> EH 29 29 <br />