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oLu <br /> MONITORING WELL INSTALLATION REPOt.. 0� <br /> Date: ) U �� CONSTRUCTION <br /> Premise Address: b°�S- 'I k�'CLQ Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Irk Bentonite (from) (to) <br /> Inspector: .� Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Comp uo-n - Stove pipe/christie box (circle one) <br /> Drilling Company-. — <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist <br /> ABOVE-GACUND CtMM-SoX <br /> COAFLETION COMPLETION <br /> SPECIAL PERMIT I O. Ground Sudws <br /> Distance to sewer line Otout <br /> Domestic well on site - (y/n ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> SAMPLING A, <br /> sac7cn = <br /> S <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) �� lf(, <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size , <br /> GROUTING Bags cement <br /> i Buckets bentonite <br /> Depth to water 2 ?D Bags sand/gravel <br /> Mix Ratios Filter Pack type/size /v <br /> Installation Method Surge Block: - (y/ <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />