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MONITORING WELL INSTALLATION REPORT <br /> /L��OG CONS RUCTION <br /> Date: <br /> Total Depth <br /> Premise Address: as 7dlJ � � <br /> Screen Length (from) (to) <br /> Filter Pack (from) (to) <br /> Well No.: Bentonite (from) (to) <br /> L l Grout (from) (to) - <br /> Inspector: Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. // Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Y_ casing <br /> Driller: , - .� height <br /> Consultant <br /> Geologist Ajc-vE-GFCUND C>�iSTY�pX <br /> C0NVLE CN COMPLET CN <br /> Ground Suiaci <br /> SPECIAL PERMIT INFO. <br /> 0rout <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) ft. <br /> If yes, location and distance - ft' <br /> _ O <br /> O <br /> tIoh" = c <br /> SAMPLING t9cicn <br /> _ 71Y91 Pz <br /> Holding Temperature =_ <br /> Method <br /> Screenin;Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) Casing type <br /> Storage Location Blank ft. Screen n• <br /> Slot size <br /> GROUTING Bags cement <br /> / Buckets bentonite <br /> Bags sand/gravel - <br /> Depth twater Filter Pack type/size <br /> Mix Ratios Surge Block: - (y/ n ) <br /> Installation Method Discussed with geologist: - ( y/ n ) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />