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*ONITORING WELL INSTALLATION REPOnT <br /> lL/16�� CONSTRUCTION <br /> Date: <br /> 2V�P 6 D $ Total Depth <br /> Premise Address: Screen Length (from) (to) <br /> Filter Pack (from) (to) / <br /> Well No.: Mf v Bentonite (from) (to) <br /> Grout (from) (to) 0 <br /> Inspector: Drilling rig type <br /> 6 Auger O.D. I.D. <br /> Permit No. / J'�•/ Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: I height <br /> c <br /> Consultant &ON Geologist '^��' �'"'^ f ABOVE-GROUND COMPLETION <br /> Greurd Surface �.. <br /> SPECIAL PERMIT INFO. <br /> ? proal <br /> Distance to sewer line / ft. <br /> Domestic well on site - (y n J ft <br /> If yes, location and distance - Ij n — <br /> = m <br /> - m <br /> C <br /> slotted <br /> SAMPLING wc5on <br /> Holding Temperature <br /> Method <br /> Screening Method — <br /> Tracking Sheet - (y/ n ) /n <br /> SPOILS <br /> Storage Method /t.i'< 07ti MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Casing type ft. <br /> Storage Location Blank ft. Screen <br /> Slot size µ �� <br /> GROiTCING Bags cement Zb <br /> Buckets bentonite 2 <br /> r3 r Bags sand/gravel <br /> Depth to water W Filter Pack type/sizes <br /> Mix Ratios Surge Block: - (y(n y <br /> Installation Method `� <br /> Quantity Installed Discussed with geo oglst: - (y 0 <br /> Type of method <br /> EH 29 29/ <br />