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<br />ft <br />ft <br /> <br />casing <br />height <br />119 <br />ALC' )VE-GROUND <br />COMPLETION ;STY-30 X <br />N <br />O. <br />P <br />OS <br />MONITORING WELL INSTALLATION REPORT <br />Date: <br />Premise Address: 30 3L G4i0v-A4-41)iZJ <br />Well No.: /004c) a144 <br />Inspector. 1161,144''t( <br />Permit No. <br />Drilling Company: <br />Driller: <br />Consultant <br />Geologist el (4•:AI04-/i) <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 Li C <br />Method VOA <br />Screening Method <br />Tracking Sheet - y / n ) <br />SPOILS <br />Storage Method AI hZ Lit,g11 <br />Contamination Nocsd n) <br />Storage LocationSE" ( <br />GROUTING <br />Depth to water t. <br />Mix Ratios <br />installation Method <br />Quantity Installed <br />CONSTRUC [ION <br />Total Depth <br />Screen Length (from) (to) <br />Filter Pack (from) (to) <br />Bentonite (from) (to) <br />Grout (from) (to) <br />Drilling rig type <br />Auger OD. I.D. <br />Completion - Stove pipe/christie box (circle one) <br />MATERIALS/DEVELOPMENT <br />Casing type <br />Blank 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. •