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MONITORING WEINSTALLATION REPORT <br /> LL <br /> i <br /> CONSTRUCTION <br /> Date• T �� <br /> Total Depth <br /> Premise Address: Screen Length (from) <br /> Filter Pack (from) (to) <br /> Well No.: Bentonite (from} (to) <br /> ' Grout (from) (to)� <br /> Inspector. Drilling rig type <br /> Auger O.D. LD. <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller. height <br /> Consultant <br /> - t <br /> Geologist1 BOVE-GROUND, �' s t4:61 STY-Box' <br /> �'. '` k' '_ COWPL.ETfON COMPt_mcN <br /> G=rd Suriacs <br /> SPECIAL PERMIT INFO. <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n,) ^ tt. <br /> ft. <br /> If yes location and distance- <br /> U ':1 <br /> SAMPLING <br /> &I red <br /> 72 91 Pack <br /> Holding Temperature — <br /> Method <br /> Screening Method <br /> Tracking Sheet - {y/ n ) <br /> SPOILS ,. r <br /> , a <br /> MATERIALS/DEVEI.OPMENT <br /> E <br /> Storage Method <br /> Contamination Noted - (y j�n)t ti e ��^-e �` l <br /> .. - Casing type t ft. <br /> Storage Location Blank ft. Screen <br /> Slot size <br /> GROUTING - Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water 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 /> IIS <br /> I <br />