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••• <br />ABOVE-GROUND <br />COMPLETION <br />casing <br />height <br />Ground Surface <br />grout <br />It. <br />MONITORING WELL INSTALLATION REPORT <br />Date: MAI <br />Premise Address: 1/1A-?ji"-- c I26-4 fn k, <br />Well No.: 6d-9 g•-"/(' <br />Inspector: <br />Permit No. e Ode' C 3&41C- <br />Drilling Company: <br />Driller: <br />Consultant ctS <br />Geologist 7:1-c-A-^- r?-7M1 <br />SPECIAL PERMIT INFO. <br />Distance to sewer line <br />Domestic well on site - ( y / n) <br />If yes, location and distance - <br />SAMPLING <br />Holding Temperature cc <br />Method &It Vit tio.A <br />Screening Methodi Cc. ) re4 <br />Tracking Sheet - q yj/ n) <br />SPOILS <br />CONSTRUCTION <br />Total Depth id- <br />Screen Length (from) (to) <br />Filter Pack (from) (to) <br />Bentonite (from) (to) <br />Grout (from) (to) <br />Drilling rig type <br />Auger 0.D. I.D. <br />Completion - Stove pipe/christie box (circle one) <br />Storage Method /4 <br />Contamination Noted - <br />Storage Location NIA <br />GROUTING <br />, <br />Depth to water 4D b) <br />Mix Ratios C_Lkut <br />Installation Methodt A../44A <br />Quantity Installed <br />MATERIALS/DEVELOPMENT <br />Casing type <br />Blank ft. ft. Screen ft. <br />Slot size <br />Bags cement <br />Buckets bentonite <br />Bags sand/gravel <br />Filter Pack type/size <br />Surge Block: - ( y / n) <br />Discussed with geologist: - ( y / n) <br />Type of method <br />EH 29 29