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� r.I <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: okle CONSTRUCTION <br /> 7 p <br /> Premise Address: �c70 Total Depth <br /> Screen Length (from) (to) <br /> Well No.: (3-f Z- Fitter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. T.D. <br /> Drilling Compan <br /> ss � . ' Completion - Stove box (circle one) <br /> y: C/ ��'•°"� ve pipe/c <br /> Driller: casing <br /> height <br /> Consultant—ALL', <br /> Geologist 1rh._4 <br /> ABOVE-GROUND <br /> COMPLETION C�iAi5TY-$OX <br /> SPECIAL PERMIT INFO. Ground Surfa" COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) 2-0I� UO <br /> If yes, location and distance - <br /> ft. � <br /> SAMPLING siottad <br /> �- &*clon A� _ <br /> Holding Temperature v� — <br /> Method_A, t _T,&'sgravlwPacks <br /> Screening Method eti) _ <br /> Tracking Sheet - (CV/ n ) <br /> ft. q— ft. <br /> SPOILS 7 SS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - {y/n ) <br /> Storage Location Casing type 6-"6 P � <br /> Blank ft. Screen_ ft- <br /> Slot size <br /> GROUTING Bags cement <br /> i Buckets bentonite <br /> Depth to water-411 6 Bags sand/gravel <br /> Mix Ratios A-.A,.� Filter Pack type/size <br /> Installation Method_- 2� 5 Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />