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MONITORING WELL INSTALLATION REPORT <br /> Date: ­7 CONSTRUCTION <br /> Premise Address: Total�- �J' (}C�-f� Total Depth <br /> 1 Screen Length (from) 70 -(to) � <br /> Well No.: Filter Pack (from) -7 _(to) C/7 <br /> Bentonite (from) -$ (to) �I <br /> Inspector: Grout (from) -S <br /> 2 �} Drilling rig type_ V\-�} <br /> Permit No. Auger O.D. -3 'N I.D <br /> Completion - Stove pipe/ stie x (circle one) <br /> Drilling Company: �-a� <br /> Driller: T-`� casing <br /> height <br /> Consultant jil T <br /> Geologist VA:; RT <br /> ABOVE-GROUND <br /> ' <br /> COMPLETION CHRISrY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sudws <br /> Distance to sewer line afout <br /> Domestic well on site - {y/n} <br /> If yes, location and distance - <br /> ft. ft. <br /> — c <br /> SAMPLING = <br /> slotted � <br /> aacton — <br /> Holding Temperature <br /> - Method _ g"al P <br /> ack <br /> Screening Method I — <br /> Tracking Sheet - (y/n) ~< <br /> .a- <br /> tt. <br /> SPOILS <br /> Storage Method Cr �` MATERIALS/DEVELOPMENT f <br /> Contamination Not <br /> Storage Location Casing type U <br /> Blank ft. Screen <br /> Slot size C� Z <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type ize <br /> Installation Method Surge Block: y n ) <br /> Quantity Installed Discussed with ologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />