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MONITORING WELL INSTALLATION REPr <br /> NS_ '�N <br /> Date: �U�3iAU6 CO <br /> Total Depth <br /> Premise Address: +�� 1 . Screen Length (from)_---(to)(to) <br /> Filter Pack (from)—(to) <br /> Well No.: Q" Bentonite (from)__(to) <br /> Grout (from),___ <br /> Inspector: Drilling rig type <br /> Auger O.D. — <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: �S� <br /> casing <br /> Driller: height <br /> —WW-F <br /> Consultants" <br /> Geologist ABCVE-GROUND C4iR1M-BOX <br /> Oo1`fLETION COMPLETION <br /> G=rid Ste <br /> SPECIAL PERMIT INFO. <br /> proof <br /> Distance to sewer line ��ft <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - tt' <br /> m <br /> tl <br /> O <br /> SAMPLING <br /> Holding Temperature = 7'VW Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> ft. = n <br /> SPOILS �U ��✓� �0 <br /> Storage Method MATERIALS/DEVELOPIvEN7 <br /> Contamination Noted - ( y/ n) 11 ,, // <br /> Storage Location Casing type�� PVC, � `O <br /> Blank k�W.a.k ft. Screen_ � n, <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 /> Type of method <br /> EH 29 29 <br />