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MONITORING WELL INSTALLATION REPT <br /> Date: 2 © CONSTRUCTION <br /> Premise Address: `(30 S: ISS '� Total Depth 52 <br /> Screen Length (from) 3Z <br /> Well No.: Filter Pack (from) (to) <br /> J Bentonite (from) (to) <br /> Inspector: `C--c _ Grout (from) (to) <br /> kZ Qa Jf 5 78<-I Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> �+ <br /> Drilling Company: Completion - Stove pipecli <br /> / ristie box (circle one) <br /> _-- C,fCC� --- <br /> Driller: casing <br /> ✓ <br /> height <br /> Consultant <br /> Geologist <br /> ABOVE-GROUND <br /> OO PL.ETION CHRiM-BOX <br /> cOMPLmoN <br /> SPECIAL PERMIT INFO, GroundSuAa= �.,,,,,,.,�,.,. <br /> Distance to sewer line grow <br /> Domestic well on site - {y/ n ) • <br /> If yes, location and distance - f. <br /> ft. <br /> SAMPLING <br /> jWl4.N Y. � <br /> Holding Temperature F <br /> Method gr"vel ` <br /> Screening Method <br /> k. <br /> Tracking Sheet - {y/ n) —_ <br /> IL ~ = —ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <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 Bags sand/gravel <br /> Mix Ratios Filter Pack typesize <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n) <br /> Type of method <br /> EH 29 29 <br />