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MONITORING WELL INSTALLATION REPORT <br /> Date: 31 CONSTRUCTION <br /> Premise Address: C; C. Total Depth 3 <br /> Screen Length (from) (to) <br /> Well No,: Filter Pack (from) (to} <br /> ' Bentonite (from) /6' (to)-- <br /> Inspector: i c Grout (from) (to) <br /> q Drilling rig type I ' + „✓� <br /> Permit No., _ c�13_ Auger O.D. I.D. <br /> —Q� Completion - Stove pipe/du-istie box (circle one) <br /> Drilling Company-.A/� �/� <br /> Driller• casing <br /> 1—:Fhelght <br /> Consultant_ <br /> Geologist e4', r <br /> ABOVE-Gcgc(JND C}iRgSTY-BOX <br /> OOMPLErION COS P EMON <br /> SPECIAL PERMIT INFO. Ground Sudwe <br /> Distance to sewer line Gfdut <br /> Domestic well on site - (y/ n) ft- <br /> If yes, location and distance - ft- <br /> �ft. <br /> V' m <br /> SAMPLING <br /> aacicn � <br /> Holding Temperature FaVVI <br /> ack <br /> Method _ F <br /> Screenin;Method <br /> Tracking Sheet - {y/ n ) 3 f � <br /> tt <br /> `to tt. ' <br /> SPOILS <br /> Storage Method cl ,5 t 4Y _ MATERIALS/DEVELOPMENT <br /> Contamination Noted - {y/ n} --�_, , P \[ C_ <br /> Storage Location Casing type <br /> Blank 1`S ft. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n } <br /> Quantity Installed Discussed with geologist: - (y/ n } <br /> Type of method <br /> EH 29 29 <br />