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r <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: dal �� ( CONSTRUCTION <br /> Premise Address: bo , YY\ in..11`.--� Total Depth <br /> Screen Length (from) (to) <br /> Well No... <br /> Gi-o �A' Filter Pack (from) (to) <br /> p Bentonite (from) (to) <br /> Inspector: /�� Grout (from) (to) <br /> .Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/clu-istie box (circle one) <br /> Drilling Company: 1n,CTe/X <br /> Driller: casing <br /> height <br /> Consultant_ <br /> Geologist AiCVE-GRC4JN0 <br /> COMPLETION ChA:STY-30X <br /> COWPLETICN <br /> SPECIAL PERMIT INFO. Crourd Svlws <br /> pra.K <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - ft. <br /> q:. M <br /> O <br /> SAMPLING sock _ <br /> socicn = � <br /> Holding Temperature = gave <br /> Method two <br /> Screening Method <br /> Tracking Sheet - (y/ n) CL <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) '3I �' <br /> Storage Location Casing type `I — <br /> � �� <br /> Blank ft. Screen_ '� fT- <br /> Slot size b <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> s Filter Pack type/size <br /> Mix Ratio <br /> -Installation Method Surge Block: - (y/n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) — <br /> Type of method <br /> EH 29 29 <br />