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MONITORING WELL INSTALLATION REPORT <br /> Date: y I CONSTRUCTION <br /> Premise Address: Total Depth <br /> .� Screen Length (from) (to) <br /> Well No.: �Z ,3 �-� f l Filter Pack (from) 0 (to) <br /> Bentonite (from) (to) <br /> Inspector: 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 /> Driller: casing <br /> t height <br /> Consultant 7M V <br /> —QV-F <br /> Geologist •- <br /> ABCVE-GaCUND C4 SZTY-8CX <br /> 00fFLET10N COMPL°TICN <br /> SPECIAL PERMIT INFO. Gourd Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) 7 ft. <br /> If yes, location and distance - <br /> 0 n• <br /> tt. <br /> SAMPLING •Iors.d c <br /> sacicn <br /> Holding Temperature = Ravi 1% <br /> ack <br /> Method = <br /> Screening Method r <br /> Tracking Sheet - ( y/ n ) <br /> ft. ft• <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type <br /> Blank /0 ft. Screen %P-,O ft. <br /> Slot size 0.02-,6 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water �d Bags sand/gravel <br /> Mix Ratios Filter Pack type,/J�' e <br /> Installation Method Surge Block: - &� n ) <br /> Quantity Installed Discussed with geologist: - 0/ n ) <br /> Type of method <br /> EH 29 29 <br />