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MONITORING WELL INSTALLATION REPORT <br /> Date: 5�3 U/b Z CONSTRUCTION <br /> Premise Address:—/ �G /� C� Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> p Bentonite (from) (to) <br /> Inspector: l ^^� Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: <br /> I height <br /> Consultan7//, <br /> Geolo 'st /-� <br /> fi /COVE-GRCUND \ <br /> CC h�L_�CfO N ChA;S7Y-80X <br /> CC APL--nCN <br /> SPECIAL PERMIT INFO. Grot d Sisfacs <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - ft• <br /> ft. <br /> C <br /> O <br /> SAMPLING •loro.i <br /> Sac-= xx <br /> _ <br /> Holding Temperature <br /> Method =< _ <br /> Screening Method = <br /> Tracking Sheet - ( y/ n) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> glwik ft. Screen ft. <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/ ii ) <br /> Quantity Installed Discussed with geologist: - ( y/ n } <br /> Type of method <br /> EH 29 29 <br />