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Q <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth 2-06 <br /> Well No.: Screen Length (from) I <br /> Filter Pack (from) I (to)-- z;e <br /> Bentonite (from). (to) ��T <br /> Inspector- Grout (from). to <br /> Drilling rig type <br /> Permit No. C- Z_ Auger O.D. to I.D. <br /> W\,^,A Completion - Stove pipe/cliristie box (circle one) <br /> Drilling Company-,_IAS e-A VN'.' <br /> Driller: <br /> casing <br /> height <br /> Consultant__(4 V?: <br /> Geologist ar\/ L <br /> VT <br /> ABCVE-GRMNO <br /> CONFLEETCN <br /> SPECIAL PERMIT INFO. COMPUnCN <br /> Distance to -,ewer line grout <br /> Domestic well on site - y/ n <br /> If yes, location and distance , <br /> 9 - 'f <br /> 11. - ft. <br /> _W <br /> SAMPLING <br /> Holding Temperature <br /> Methodnvaic <br /> Screening Method <br /> Tracking Sheet y n <br /> SPOILS <br /> Storage Method MATERIALs/DEvuopmENT <br /> Contamination Noted - (.y n <br /> Storage Location J Casing type_ Z_" FV__L_ <br /> Blank t X ft. Screen I's j <br /> �GROUTING Slot size <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> Mix Ratios Bags sand/gravel- <br /> Filter Pack type/size <br /> Installation Method Surge Block: - (y,<j-jj <br /> Quantity Installed \._7 <br /> Discussed with geologist: - y <br /> EH 29 29 Type of method <br />