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MONITORING WELL INSTALLATION REPORT <br /> Date: 111406 1406 CONSTRUCTION <br /> Premise Address: WS-6 / &�k Total Depth (3 0 <br /> Well No.: C <br /> lA,) Al� r Screen Length (from) [ (to) [[0 <br /> / p Filter Pack (from) [ 10 (to) 107 <br /> Inspector. Bentonite (from)_ (0; (to) ", <br /> Grout (from) [ (t /l <br /> .Drilling rig type. <br /> Permit No. Auger O.D. I.D. <br /> / <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> 6 t'S <br /> Driller: casLng <br /> /� height <br /> ,.m <br /> Consultant I�-cb...� 1711 <br /> Geologist Pte('n � T <br /> ABOVE-GROUND <br /> COMPLETION 4iISTY-80X <br /> SPECIAL PERMIT INFO. Groundg�xy CCHR PMICN <br /> Distance to sewer line VA grout <br /> Domestic well on site - (y/ n ) ft, <br /> If yes, location and distance - <br /> • tt. <br /> tt. <br /> ^bT :IT <br /> O <br /> SAMPLING Monod = o <br /> tocicn — <br /> Holding Temperature =_ <br /> Method <br /> Screening Method =F' <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> Blank //U ft. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 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 /> EH 29 29 Type of method <br />