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0 • <br /> LL <br /> MONITORING WEINSTALLATION REPORT <br /> Date: <br /> Zf Gam' CONSTRUCTION <br /> Total Depth <br /> Premise Address: <br /> Screen Length (from) (to) <br /> Z Filter Pack (from) (to) <br /> Well No.: Bentonite (from) (to) <br /> Grout (from) (to) <br /> Inspector. Drilling rig type <br /> Auger O.D. pipe/cluiLD. <br /> Permit No. Completion - Stove stie box (circle one) <br /> Drilling Company: y w <br /> casing <br /> Driller•. height <br /> Consultant \ <br /> Geologist JA' ���"' ABOVE-GFICUND <br /> C4-(Ft:STY-30X <br /> coWLETION CGWPL-TCN <br /> Groutxl Suixs <br /> SPECIAL PERMIT INFO. <br /> ptcut <br /> Distance to sewer line ft. <br /> Domestic well on site - (y/ n) tt. <br /> If yes, location and distance - ti <br /> � M <br /> �^F O <br /> C <br /> O <br /> LO <br /> SAMPLING <br /> SAMPLING socicn <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> MATERI ALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted - (y/ n) Casing type h, <br /> Storage Location Bl fr Screen — <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gravcl <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - (y <br /> -,Installation Method Discussed with geologist: - (y/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />