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MONITORING WELL INSTALLATION REPORT <br /> Date: U 6i 04 CONSTRUCTION <br /> Premise Address: `f k Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) t <br /> Inspector, Grout <br /> (from} � <br /> Drilling rig type <br /> Permit No. Auger O.D. I,p, <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller• casing <br /> height <br /> Consultant <br /> Geologist <br /> ABOVE-GROUND CHW��S iY-8dX <br /> COMPLETION COMPtE'CSCN <br /> 2PECIAL PERMIT INFO, sound Sulwo <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) tt. <br /> If yes, location and distance - ft- <br /> AA <br /> V' O <br /> «ch <br /> SAMPLING 610red G <br /> iotscn <br /> Holding Temperature _ <br /> Method — V&vW Pack <br /> Screening Method <br /> Tracking Sheet - (y/ n ) # <br /> SPOILS <br /> Storage Method MATER161:gMEVELOPMENT_ <br /> Contamination Noted - {y/n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft, <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/n ) <br /> Type of method <br /> EH 29 29 <br />