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Auger OD. <br />Completion - Stove pipe/christie box (circle one) <br />casing t <br />CX3Ni3 L1-71ON <br /> Gc•-..nc1 Scrfact <br />AL'OVE-GROUND C4-',STY-BOX • <br />MONITORING-WELL INSTALLKI1ON REPORT <br />Date: ri Of/1 coNsTRuci CON <br />Premise Address: ,3031----' titkAlar- (4-11 ) 51.1<r'' Total Depth /1 <br />Well No.: — g <br />Screen Length (from) <br />Filter Pack (from) <br />(to) <br />- Fil <br /> <br />(to) <br />Bentonite (from) (to) <br />Inspector. . Grout (from) (to) <br />Drilling rig type <br />Permit No. <br />Drilling Company: 1/{ArriA1/14 <br />Driller: <br />Consultant <br />Geologist <br /> <br />Domestic well on site - (y / n) <br />If yes, location and distance - <br />SAMPLING <br />Holding Temperature <br />Method <br />Screening Method <br />Tracking Sheet - ( y / n ) <br />SPECIAL PERMIT INFO. <br />Distance to sewer line • <br />SPOILS <br />Storage Method <br />Contamination Noted - ( / n) <br />Storage Location <br />MATERIALS/DEVELOPMENT <br />Casing type <br />Blank ft. Screen <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 /> <br />GROUTING <br />Depth to water <br />Mix Ratios <br />4nstal1ation Method <br />Quantity Installed <br /> <br />EH 29 29. . <br />