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'^iONITORING WELL INSTALLATION REPOnT <br /> Date: X ;M/ CONSTRUCTION <br /> Premise Address: Z Total Depth - <br /> f/2+" Screen Length (from) (to) <br /> Well No.: <br /> Filter Pack (from) (to) <br /> Bentonite (from) (to) � <br /> Grout (from) / (to) <br /> Inspector: Q( <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: f height <br /> Consultant 5hc?�Z4 T <br /> Geologist AE&rz.GROUND ��.-BOX T <br /> 006F ETION PLETION <br /> SPECIAL PERMIT INFO.SuAaa 7 <br /> M1 proof <br /> Distance to sewer line <br /> Domestic well on site - ( y Q ft• <br /> If yes, location and distance - ft. <br /> ft. <br /> m <br /> = o <br /> SAMPLING dotted <br /> sacdon = <br /> Holding Temperature fG _ 72YW Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet <br /> SPOILS <br /> Storage Method 'S�� I/ "^ " MATERIALS/DEVELOPMENT / <br /> Contamination Noted - (y�i vk1 � " V <br /> Storage Location Casing type <br /> Blank ft. Screen Rti fr• <br /> Slot size OJ,U <br /> GROUTING Bags cement <br /> f <br /> 64) Bw4etr bentonite 0 <br /> Depth to water = Bags sand/gravel <br /> Mix Ratios 0 4�D.LG� �/ Filter Pack type/size <br /> Installation Method D' Surge Block: - (y n <br /> Quantity Installed - ° Discussed with geo ogis - (y O <br /> Type of method Al <br /> EH 29 29 <br />