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MONITORING WELL INSTALLATION REPORT <br /> Date: 7/7 CONSTRUCTION <br /> Premise Address:_ Total Depth <br /> Screen Length (from) (to)__ <br /> Well No.: A Filter Pack (from) (to) <br /> Bentonite (from) (to) - <br /> Inspector: _� K- Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> n Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant ( - <br /> Geologist <br /> ABOVE-GROUND <br /> COMIPLETION CHRZW43OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft' <br /> ft. ft- <br /> SAMPLING = ° <br /> slattad — c <br /> / &action = <br /> Holding Temperature N <br /> Method _ �"� ` <br /> Screening Method <br /> Tracking Sheet - (y/n ) <br /> .a: <br /> A. � = n- <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Z� 1hc�S Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios i1.e R Filter Pack type/size <br /> Installation Method frn M,�,t_, Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />