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0 <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: (3/�Z CONSTRUCTION <br /> Premise Address: Total Depth V� <br /> foo Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> p Bentonite (from) (to) <br /> Inspector. < -C Grout (from) (to) <br /> Drilling rig type <br /> Permit No,— 5 R V a r (o (o Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: �'�ti-c U/ <br /> Driller: casing <br /> height <br /> Consultant �� S VIFM7 <br /> Geologist <br /> 7/1 <br /> AE&E-GACUND <br /> COWLcT10N CNAISTY-aCX <br /> CUNPLEMCN <br /> SPECIAL PERMIT INFO. Ground Sufacs <br /> Distance to sewer line <br /> prcut <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - <br /> ft. <br /> ft. _ <br /> m <br /> C <br /> SAMPLING donna <br /> soden <br /> Holding Temperature <br /> Method = t <br /> Screening Method <br /> Tracking Shcet - (y/ n ) <br /> SPOILS <br /> Storage Method bL MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) 3/y r, <br /> asing � a c <br /> Storage Location Blank type Mfr Screen fr. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 28 -30 Bags sand/gravel <br /> Mix Ratios /tic I't Cn 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 />