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760� <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from)- 11 —(to) <br /> Well No.: <br /> JYMIAA �Mi t Filter Pack (from) ue " (to) <br /> Bentonite (from) <br /> Inspector. A�� <br /> Grout (from) to <br /> .Drilling rig type <br /> Permit No. Z_ Auger O.D. in I.D. <br /> Completion - Stove pipc/cluisdebox (circle one) <br /> Drilling Company:_ lwl�r�:�c.�C1! <br /> Driller. casing <br /> Consultant IL height: <br /> Geologist <br /> ABOVE-GACUND <br /> CCWLZT061 C4_GMTY_a0X <br /> SPECIAL PERMIT INFO. Ground Surface CC*APL-rnCN <br /> Distance to sewer line gra <br /> Domestic well on site - (y n <br /> If yes, location and distance <br /> SAMPLING <br /> st <br /> sacicn <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y n <br /> ks ft. V r�-♦ <151, ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n i <br /> Storage Location- Casing We ',Z " PV <br /> Blank .....ate_ Screen. r ft <br /> 2ROLMNG Slot n <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> Mix Ratios Bags sand/gravel <br /> Filter Pack type/size <br /> Installation Method <br /> Quantity Installed Surge Block: - (Y/�Hfj <br /> Discussed with gcolo�glsr: y <br /> EH 29 29 Type of method —_V) <br /> 41 N„rd' <br />