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MONITORING WELL INSTALLATION REP''^T <br /> Date: 3Lg I0 CONSTRUCTION <br /> T <br /> Premise Address: a �. L cY.�-t Total Depth <br /> Screen Length (from) (to) <br /> Well No.: N/IA Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> `' I Completion - Stove p�e/christie box (circle one) <br /> � 4 W <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologistyt �- <br /> ABOVE-GROUND <br /> COMPLETION CHRIS 43OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) ft <br /> If yes, location and distance - <br /> ft. <br /> ft. <br /> -s <br /> - m <br /> a <br /> SAMPLING <br /> tbttad � <br /> aaaion <br /> Holding T.5mperaturevivel <br /> `( <br /> Method �tsS _ P <br /> ack <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> ft. — ft. <br /> SPOILS S (�� <br /> Storage Method MATERIALS/DE PMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type <br /> Blank f[ Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 56� Bags sand/grave <br /> Mix Ratios Filter Pack typ size <br /> Installation Method Surge Block: ( y/ n ) <br /> Quantity Installed Discussed th geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />