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• <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: iG ' //0 CONSTRUCTION <br /> Premise Address: y >� '2/Ali4ATotal Depth <br /> Screen Length (from) bd (to) <br /> Well No.: T Filter Pack (from) Ste" (to) 75— <br /> Bentonite (from) 55 (Eo)S e <br /> Inspector. (Z Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: � � <br /> Driller: <br /> I <br /> �� casing <br /> height <br /> Consultant <br /> Geologist k ( -9di" ABCVF-GaC(JND <br /> COWLETfON CMPLE30X <br /> COtiPLE'fICN <br /> rd <br /> SPECIAL PERMIT INFO. «D Suix� + <br /> prat <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - it• <br /> ft. <br /> M <br /> C <br /> O <br /> SAMPLING dorsi <br /> socicn — <br /> Holding Temperature <br /> Method <br /> Screening Method " - <br /> Tracking Sheet - (y/ n) <br /> tt. = fl. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (yasing/ n) '' <br /> Storage Location Blripe 2 ft. Screen —h• <br /> Slot size 026 — <br /> GROUTING Bags cement <br /> his bentonite c s <br /> to water Bags sand/gravel- <br /> Depth Sw < <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 />