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SAMPLING <br />Holding Temperature <br />Method <br />Screeninz, Method <br />Tracking Sheet - ( y / n ) <br />SPOILS <br />MONITORING WELL INSTALLATION REPORT <br />Date: <br />Premise Address: 2...c2ct S -1/1A9 -(//..‘ 3- <br />Well No.: A11J 2_ -t <br />Inspector: 1,),AitAnCCA....... • <br />Pen-nit No. <br />Drilling Company: Vi 1-1A) <br />Driller: AIAA‘Actc)fr-- <br />Consultant <br />Geologist .70-c_ 3 (x6, <br />SPECIAL PERMIT INFO. <br />CONSTRUCTION <br />Total Depth <br />Screen Length (from) 1 0 • <br />Filter Pack (from) <br />Bentonite (from) <br />Grout (from) .G.L.‘ t <br />Drilling rig type <br />Auger O.D. I.D. <br />Completion - Stove pipe/c.hristie box (circle one) <br />casing <br />height <br />ABC VE-GR CUND <br />COW' LET1ON C4-0RI5TY-3OX <br />Grtxxxl Sizfacs <br /> COMPLEflCN <br />Distance to sewer line <br />Domestic well on site - ( y <br />If yes, location and d• nce - <br />Storage Method <br />Contamination Noted. ( y n ) <br />Storage Location <br />GROUTING <br />MATEFUALS/DEVELOPMENT <br />Casing type <br />Blank ft. Screen ft. Slot size <br />Bags cement <br />Depth to water c\J I b <br />Mix Ratios <br />Installation Method <br />Quantity Installed <br />EH 29 29 <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 />