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MONITORING WELL INSTALLATION REPQT T <br /> .. N <br /> Date: CONSTRUCTION LM 1�i PAC2 <br /> Al V <br /> y r.�. G•v <br /> Premise Address: Total Depth -100 <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. «' "'`^'- — Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> -C mean <br /> Driller: casing <br /> he,'ght <br /> Consultant s "ir V <br /> Geologist <br /> ABO E-GACUND CNMM-aox <br /> COWLETION coiwPL.mcN <br /> SPECIAL PERMIT INFO% G=nd Sw1wo <br /> Distance to sewer line grail <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - 2,-7 ft. <br /> AA W,3 -......_...tt. <br /> •A <br /> SAMPLING <br /> tiotted — e <br /> s4t'scn �'• — <br /> Holding Temperature <br /> Method VIYW pads <br /> Screening Method M <br /> Tracking Sheet - (y/ n ) <br /> �....�..w.ft. - fL <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> ` EH 29 29: <br />