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MONITORING WELL INSTALLATION REPORT <br /> Date: JII �I1�� CONSTRUCTIONS ,J <br /> / ��__ �,�y,Q Total Depth <br /> Premise Address: / '11�- Screen Length (from) (to) <br /> Well No.: 13 Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. Grout (from) (to) <br /> _ Drilling rig type <br /> Permit No.— b0 3�) G Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: (�A _r— L <br /> casing <br /> Driller: height <br /> Consultan <br /> Geologist wr <br /> /�gpVE-GRC(JND • <br /> Ck <br /> COh9LET{ON �itSTf-c30X <br /> COMPLEMCN <br /> SPECIAL PERMIT INFO. Gmund Svfacs <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - ft• <br /> —ft. <br /> SAMPLING tlot'.ar! c <br /> socicn <br /> -- <br /> Holding Temperature. <br /> Method _ <br /> Screening Method tAIA <br /> Tracking Sheet / n) _ <br /> ft = ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) CasinId <br /> Storage Location Blankft. Screen---.ft. <br /> Slot s <br /> GROUTING Bags <br /> _ Bucke <br /> Depth to water �S IIags <br /> Mix Ratios FiltersizeInstallation Method Surgey/11 ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) — <br /> Type of method_ <br /> EH 29 29 <br />