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MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> Premise Address: SSS Z�✓�lN r RLC-4 Total Depth <br /> C�Well No.: J r� Screen Length (from) (to) <br /> 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 /> I Completion - Stove pipe/cluistie box (c�e) <br /> Drilling Company:_y °� W . <br /> Driller: casing <br /> � F height <br /> Consultant - <br /> Geologist <br /> A'.OVE-GACUND <br /> t� WWF CN D <br /> SPECIAL PERMIT INFO. / C <br /> Grwrad Sufaeq <br /> Distance to sewer line Drat <br /> Domestic well on site - (y/ n) o�If yes, location and distance . L . ft. <br /> 7 <br /> 5-ft. !t. <br /> o <br /> SAMPLING <br /> socicn 'r — � <br /> Holding Temperature — <br /> Method = pawtpadc <br /> Screening Method <br /> Tracking Sheet - (y/ n) r _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) ������ <br /> Storage Location Casing type <br /> Blank fr. Screen ( ft. <br /> Slot size •D D <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water b <br /> Bags san <br /> Miz Ratios ��,_, . Filter Pack type d/type/ <br /> installation Method Su1Z <br /> Quantity installed Surge Block: - (y/ <br /> y/n <br /> Discussed with geolo ist: - (©/ n) <br /> EH 29 29 Type of medtod <br /> O ��IGG� <br />