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%4/ <br /> MONITORING WELL INSTALLATION REP—e-T N QO <br /> Date: CONSTRUCTION <br /> Premise Address: Tota! Depth <br /> Screen Length (fro ) <br /> Well No.: Filter Pack. <br /> Bentonite <br /> Ins ector. Grout <br /> P Drilling rig type <br /> ft <br /> Permit No. Auger O-D. <br /> r Completion - `e e/diristie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> . � t <br /> heighr <br /> Consultant_ <br /> AS <br /> — � f <br /> Geologist _ • .• Cv--3FtQCiNfl <br /> GOMPL-i,CN <br /> SPECIAL PERMIT INFO. G=nd S�t� 74- <br /> r � <br /> pran <br /> Distance to sewer line <br /> Domestic well on site y n <br /> If yes, location and dis ce - �' - <br /> 0 <br /> SAMPLING �focwd <br /> f y ween _- <br /> k` <br /> Holding Temperature <br /> Method "i <br /> Screening Method Ire <br /> Tracking Sheet - (y <br /> ♦ 7t.— tt <br /> SPOILS <br /> Storage Method 4 MATERIALS/DEVELOPMENT <br /> Contaminadon Noted - (y/ ) Casin11 <br /> Blank <br /> Storage Location type <br /> Black ft. Seen fr- <br /> Slot size <br /> GROUTING Sags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack.type/size <br /> Installation Method Surge Blodk— - C y <br /> Quantity Installed Discussed with geologist~ - ( y <br /> Type of merhod <br /> EH 29 29 <br />