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MIWITORING WELL INSTALLATION REPORT ' <br /> CONSTRUCTION <br /> Premise Address: a� �� I72� wl 0e Total Depth <br /> (fro <br /> q� — 2 I Screen Length m) (to) d <br /> Well No. : Filtet Pack ) (ao) <br /> (from, 2 <br /> Inspector: I �. (A/ Q ,J �' Bentonite (from) (to)--j - <br /> Grout (from) (to) <br /> j� r� / /� a Drilling rig type <br /> Permit No. �J / 7 Auger O.D._ I.D. <br /> q. <br /> Completion - Stove pipe/chrisde box (circle one) <br /> Drilling Company: ' / <br /> Driller: t)a casing <br /> /"U I EL .1 - height <br /> . <br /> Consultant <br /> E Geologist AIMIU <br /> ABOVE-GROUND . <br /> COWLETION CHMMWX <br /> SPECIAL PERMIT INFO. COMPLETION <br /> Ground Surlxe <br /> Distance to sewer line grout <br /> Domestic well on site - ( y <br /> If yes, location and distance - ft. <br /> Le ft. - ft <br /> - m <br /> I SAMPLING <br /> alaried <br /> j Holding Temperature = <br /> Method = gmw pack <br /> Screening Method = <br /> Tracking Shee - ( y / n ) /P P ft- — ft- <br /> SPOILS <br /> Storage Method / /`J L� S / MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) <br /> Storage Location_ ( �� pft Casing type <br /> _ Blank �- ft. Screen A � ft. <br /> v 1 Slot size <br /> GROUTING Bags cement _ <br /> O Buckets bentonite E <br /> Depth to wat r Bags sand/gravel [ <br /> Mix Ratios f Filter Pack type/size <br /> Installation ethod / 1 /PVC Surge Block: - ( y / n ) <br /> Quantity Installed Discussed with geologist: - ( y / n ) <br /> EH 29 29 Type of method <br />