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MONITORING WELL INSTALLATION REPORT <br /> 06 <br /> 4 r <br /> Date: CONSTRUCTION <br /> Premise Address: 14 Lf A Total Depth <br /> %U— Screen Length (from) (to) <br /> Well No.: A A Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) -(to) <br /> Drilling rig type <br /> Permit No. 0*35-" Auger O.D. I.D. <br /> Completion - Stove pip;/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant T <br /> Geologist <br /> ABOVE-GROUND CHRZTY43OX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surlace <br /> Distance to sewer line grout <br /> Domestic well on site - y n ft. <br /> If yes, location and distance - ft. <br /> o <br /> SAMPLING slotted <br /> **don <br /> Holding Temp7tore gmvw Pack <br /> Method <br /> Screening Method AfP <br /> Tracking Sheet n J�v <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n <br /> Storage Location Casing type___L J&� <br /> Blank ft. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 4IO2 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 />