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_7 <br /> MONITORING WELL INSTALLATION REPOR•r— <br /> r � <br /> Date: CONSTRUCTION <br /> Premise Address: �' r'� ` ^ �� L,A4A.1t Total Depth <br /> r.. r Screen Length (From) / (to) I <br /> Well No.- � � p --- Filter Pack (from)_ �(to) Z <br /> y� Bentonite (From) 2 t {to) �•° � <br /> Inspector- _ Grout (from) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> Driller: casing <br /> Y be,ght <br /> Consultant �� <br /> Geologist ABOVE-GRC;c NO <br /> COMPLETION C}sGQt',MFLc-PLEE 30X <br /> TiCiJ <br /> SPECIAL PERMIT INFO. 'Sx� <br /> gra.K <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - + h- <br /> tt. <br /> - M <br /> C <br /> SAMPLING �/D�� �� j -..- G��G� slow <br /> socicn <br /> Holding Te <br /> peratore F pYvar;acic <br /> Method { <br /> Screening Method .r — <br /> Tracking Sheet - ( 1/ n ) .21 <br /> -- ----- <br /> SPOILS <br /> Storage Method1�'`"�'�'� <br /> MATERIALS EVELOPMENT <br /> Contamination Noted - C Y �r) +I <br /> Storage Location Casing typ <br /> Blank ft. Screen L <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite s.. <br /> Depth to water Bags sand/graveI <br /> type/ <br /> Mix Ratios Filter Pack size '2 ti <br /> + <br /> Installation Method Surge Block: - (y/ tz ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of rncthod <br /> EH 29 29 <br />