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MONITORING WELL INSTALLATION REPORT <br /> Date:` 30�0 S' <br /> CONSTRUCTION • <br /> Premise Address: , <br /> Total Depth 5 <br /> Well No.: Screen Length (from) 6 S` <br /> Filter Pack (from)_ (,3 ' (to) , <br /> Inspector. Bentonite (from) o ' <br /> .r . Grout (from) (to) > <br /> Permit No. Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company, i? Completion - Stove pipe/christie box (circle one) <br /> Driller. <br /> casing <br /> Consultant he_ght <br /> 4 <br /> i <br /> Geologist ,r T <br /> I A�,CYE-GRCCND T <br /> CCWLETICN C+ xRZ Y-Box <br /> SPECIAL PER_.�fIT INFO. COMOL`ncN <br /> Distance to sewer line <br /> Domestic well on site - (y/ flrw4 <br /> if yes, location and distan 4 ft. <br /> SAMFUNG <br /> Holding Temperature t .soden - <br /> Method <br /> Screening Method <br /> Tracking <br /> Sheer - (p n ) <br /> SPOILS --�l�tt. ft. <br /> Storage Method ` <br /> Conta_rnination Noted - MATERIALS EVEI.OPMENT <br /> (y/n <br /> Storage Location _ Blantyp <br /> k <br /> 4, s" ft. Screen_ h, <br /> GREG Slot size �Ozo <br /> Bags cement <br /> Depth to water •.> �-G1 Buckets bentonire <br /> Mix Ratios Bags sand/graveI <br /> Installation Method Filter Pack type/size—__p _ <br /> Quantity Insta]Icd Surge Block: - (0/ n ) <br /> Discussed with geologist: - (O/ n ) <br /> EH 29 29 Type of method <br />