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J <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: 7 /U CONSTRUCTION <br /> Premise Address, �' Z S. Total Depth <br /> Screen Length (from) (to) <br /> Well No.: M tk) 1 S - Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Grout (from) (to) <br /> Inspector. ti C K e _ <br /> Drilling rig type <br /> Perini[No. <br /> �� "32 L� Auger O.D. ")- g LD. <br /> Completion - Stove pipe/clu-istie box (circle one) <br /> Drilling Company: U �� w <br /> �� casing <br /> Driller: <br /> height <br /> Consultant �v ��� � erQ �w:�c�sS � ` <br /> Geologist 13Pc, ` UPS A80VE-GaCIJNp <br /> ox <br /> COtiPL.E fON CNRSiY <br /> COME71CN?LCN <br /> SPECIAL PERMIT INFO. ��Grwcd Suir� <br /> ptat <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - n. <br /> n. <br /> _ o <br /> — a <br /> SAMPLING socJcicn _ � <br /> Holding Temperature _ _ <br /> Method `a = <br /> Screening Method — <br /> Tracking Shcet - (y/ n ) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVEI OPMENT <br /> Contamination Noted - (y/ n) Casinga � 'k �, ) 5tLa� _ <br /> Storage Location _ft. <br /> Blank fr. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Filter Pack type/size <br /> Mix Ratios <br /> Surge Block: - geologist: <br /> /n <br /> Installation Method ) <br /> Discussed method geologist: - (y/ n <br /> Quantity Installed ) <br /> Type of method <br /> EH 29 29 <br />