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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: <br /> S o�(tel Total Depth 0 <br /> Screen Length (from) 40 (to) <br /> Well No.: }� _ - Filter Pack (from)_R !3 1) —(to) <br /> Bentonite (from)_ "9a-- (to) <br /> Inspector: Grout (fro � (to) <br /> Drilling rig type m <br /> Permit No. _. Auger O.D. 211 <br /> IA.) <br /> A � Completion - Stove it pip c tie b (circle one) <br /> Drilling Company:, <br /> Driller: caa Lng <br /> - q he_ght <br /> Consultant <br /> Geologist "`�'� ABOVE-GRC:UND <br /> CO h�LEI'f0 H Ci-�i�57Y-2oX <br /> co+ L=nCN <br /> SPECIAL PERMIT INFO. around SLOac+ <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - ft• <br /> ft. <br /> f: <br /> _ O <br /> SAMPLING sEor.� c <br /> sacicn <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ ntL <br /> ) <br /> ..,L_. <br /> SPOILS <br /> Storage Method MATERIALS EVEL.OPMENT <br /> L <br /> Contamination Noted - (y/ n) <br /> Storage Location Casing e <br /> Bl ft. Screen S K• <br /> Slot size <br /> GROUPING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> ISurge Block: - ( y/ <br /> Installation Method jl } <br /> Quantity Installed Discussed with geologist: - (y/ n } <br /> Type of method <br /> EH 29 29 <br />