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MONITORING WELL INSTALLATION REPORT <br /> Date: �"� CONSTRUCTION f <br /> Premise Address:- Li�1 (- --4- W C `n.u�' Total Depth V <br /> Screen Length (&om) L (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from} -(Co) <br /> Inspector* Grout (from) <br /> (to) <br /> Drilling rig type < <br /> Permit No._ l� c Auger O.D. <br /> Completion - Stove pipe c u stie b x (circle one) <br /> Drilling Com�pan?y: a <br /> casing <br /> Driller: v G'��-- <br /> . he, <br /> Consultant -10T <br /> Geologist A80vE-Gr1CUND <br /> C TION <br /> C0NVL-E-7CN MPL=- <br /> ca ..rncN <br /> SPECIAL PERMIT INFO. Ground Sumacs <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - C y/ n <br /> If yes, location and distance - � <br /> 0 <br /> SAMPLING slorad = c <br /> :Qricn <br /> Holding Temperature <br /> Method <br /> Screening Method ` <br /> Tracking Sheet - (y/ n ) j j� �. ��. ; _ Lo L- <br /> tt- <br /> SPOILS <br /> �5 'G�-�"' tL MATERIALS EVELOPMENT <br /> Storage Method <br /> �� 'r <br /> Contamination Noted - {y/ n ) Casing type V C- <br /> Storage Location Blank fr. Screen ft- <br /> Slot size <br /> GROLMNG Bags cement <br /> C ( Buckets bentonite <br /> nis a S nags sand/gravel <br /> Depth to water <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />