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'10NITORING WILL INSTALLATION REPT <br /> Date: ( 'Z �l OSS C-NSTRUCT'ION <br /> Premise Address: <br /> �2 (�, dD Alt Total Depth <br /> Screen Length (from) (to) <br /> Well No.: r' '"cef Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> GeoWt _ ABOVE-GROUND <br /> COMPLETION C.tiRiSTY-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground <br /> grafi <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - ft. <br /> SAMPLING �O'� sbttad <br /> aacoo = <br /> Holding Temperature C& _ '. Brawl pack <br /> Method «. <br /> Screening Method X — <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> Storage Method MATERIAIS/DMM OPMENT <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 SD-S'/ r 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 />