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MONITORING WELL INSTALLATION REPORT <br /> Date: ��l t CONSTRUC'T'ION <br /> Premise Address: 7 S 8U u'-��� Total Depth 7K <br /> Screen Length (from) (to) <br /> Well No:: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. �j /� Grout (from) (to) <br /> Drilling rig e <br /> Permit No. Auger O.D. I.D. L <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company:_ _ V <br /> Driller: casing <br /> height <br /> Consultant Sh � 6� <br /> Geologist ( LL 9 - ABOVE-GRCUNO <br /> ChR <br /> COWLETCN a�U 30X <br /> cmcN <br /> SPECIAL PERMIT INFO. Crwcd S acs <br /> prcc.•t <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft- <br /> tt. <br /> _ M <br /> C <br /> O <br /> SAMPLING iloro.i <br /> Holding Temperature Y' <br /> Method Q n-, b-&-- 2 _ <br /> Screening Method <br /> Tracking Sheet - (y/ n) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank Screen_-----.ft. <br /> ft• <br /> Slot size <br /> GROUTING Bags cement <br /> _ Buckets bentoni — <br /> Depth to watet!'-�'S Bags sand/grav 1 <br /> Mix Ratios /+ti o Filter Pack a/size <br /> -installation Method Surge Block' - ( y/ n ) <br /> Quantity Installed Discussed rith geologist: - ( y/ n) — <br /> Type of cthod <br /> EH 29 29 <br />