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I 'gITORING WELL INSTAL!.ATION REPORT <br /> gate; CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Lengrh (from) (to) <br /> Well No.: Filter pact (from)- -(to)�� <br /> Bentonite (from) (to) <br /> inspector Grout (from) (to)— <br /> Driiling rig type <br /> ?ermit No. Auger O.D. l.D. <br /> Completion - Stove pipe/chrisde boa (circle one) <br /> Drilling Company: <br /> Driller. <br /> Consultant <br /> Geologist AEZVE-GRC- .'NO " <br /> CCMPL-1 ICN <br /> SPECIAL INFO. Grasr�d Suits <br /> i <br /> bras <br /> Distance Lo sewer line J <br /> Domestic well an site - ( Yif yes, location and distance - ft- <br /> SAMPUNG iiara,i <br /> ' e sac:ca <br /> folding 7emperac Mer-hod TIE- <br /> Screening <br /> IE- <br /> Screening Method <br /> -racting Shce: - ( y/ n ) <br /> IF <br /> SPOILS <br /> Storage Method MA^'ERIALS/DEVcY.OPMEN-T <br /> Contamination voted - C Y/ n ) <br /> Storage Location Casing type <br /> Blank rt. Screen <br /> SIot size <br /> GROUPING Bags cement <br /> Buckets benconire <br /> Deorh to water Bags sand/gravel <br /> Mix Ratios Filte-r Pack type/size <br /> ?rstaiiat or. 1r1e�`:od Surge Mock. - C Y/ n ) <br /> Quantity installed Discussed with geologist: - <br /> Type or'method <br /> H '19 29 <br />