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MONITORING WELL, INSTALLATION REPORT <br /> i <br /> Date: CONSTRUCTION <br /> Premise Address :_ /oLtb ESP <br /> Total Depth z� <br /> / til / Screen Length (from) /OU (to) / Zo <br /> Well No. : `Y Fite* Pack (fi c ) 4 0 (to) Z5 <br /> Bentonite (from) `7 6 (to) B <br /> Inspector: oo<j n ) (to) <br /> Q� Grout (from) 0 <br /> Permit No 7�y7d <br /> Drilling rig type <br /> Auger O.D. �j ` I.D. <br /> Drilling Company: <br /> n � Completion - Stove pipe/christie box (circle one) <br /> /-/ <br /> Driller: Jtocoe/y <br /> Oaring <br /> 4 height <br /> Consultanty'T ♦ ' <br /> Geologist pRNL4k V 14LOgNaEyg <br /> ABOVE-GROUND <br /> COMPLE-mN CHRIST-BOX . <br /> SPECIAL PERMIT INFO, COMPLETION <br /> Ground Surface <br /> Distance to sewer line or« t <br /> Domestic well on site - ( y / n ) <br /> If yes, location and distance - ft. <br /> (G6 ft. ft. <br /> w . <br /> SAMPLING — o <br /> . dotted <br /> wc5an _ <br /> Holding Temperature — <br /> Method = 9R p <br /> Screening Method = <br /> Tracking Sheet - ( y / n ) <br /> tt. <br /> SPOILS (� <br /> Storage Method 1N F:3 ' Au MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) y <br /> Storage Location pKyS ( rE Casing type Z Ptr <br /> Blank 04Vo ft. Screen 1664Z' $ <br /> Slot size <br /> GROtPPING Bags cement <br /> Buckets bentonite_ <br /> Depth to water Bags sand/gravel <br /> � <br /> Mix Ratios Filter Pack type/size — ?i <br /> Installation Method Surge Block: - ( y / n ) <br /> Quantity Installed Discussed with geologist: - ( y / n <br /> EH 29 24 Type of method <br />