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MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> CONSTRUCTION <br /> Premise Address: / hh <br /> Total Depth 6 V <br /> Well No.: _S�� Screen Length (from)_ <br /> Filter Pack (from)-----V-f2,1—(t0) Ez2 <br /> Inspector. Bentonite <br /> Grout (from)- -��----(to)=-�� 7,� <br /> _ <br /> (from)_ (to)-- - <br /> Permit No. Drilling rig type <br /> Auger O.D. I.D._ <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: IT7 <br /> casing <br /> Consultant '4 height <br /> Geologist <br /> ABCVE-Gac(JND <br /> 00&VLZr)0N �:KAtST`f-30X <br /> SPECIAL PERMIT INFO. COWLMN <br /> Ground sulacs T <br /> Distance to sewer line t <br /> Domestic well on site - (y/ n ) <br /> proof <br /> If yes, location and distance <br /> SAMPLING <br /> tlorsi _ _— c <br /> Holding Temperature i0C'o" <br /> Method qM,,'W <br /> Screening Method = <br /> pacx <br /> Tracking Sheet - (y/ n ) ' <br /> ft. ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type-_ oZ " py <br /> Blank S-4, ft. Screen '2. <' <br /> GROUTING Slot size_ 4 0-2--d <br /> Bags cement <br /> Depth to water Buckets bentonite_ <br /> Mix Ratios Bags sand/gravel <br /> Installation Method Filter Pack type/size <br /> Quantity Installed Surge Block: - (y/ n ) <br /> Discussed with geologist: - (y/ n <br /> EH 29 29 Type of method <br />