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MONITORING WELL INSTALLATION REPT <br /> Date:_ /4 r _ CONSTRUCTION ' <br /> Premise Address: VVI, lam' h � 1� Gi,� �iav Total Depth <br /> Screen Length (from) (to) <br /> Well No.: +� Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. _ �!+ /l Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> he±ght <br /> Consultant a, <br /> Geologist .. <br /> ABOVE-GRCUND CHR*'TY-SOX <br /> COMPLETION COMPLETICN <br /> SPECIAL PERMIT INFO. Ground Sudws <br /> Distance to sewer line-- grout <br /> Domestic well on site - (y/ n) G w�T i N`L-,2— 1 <br /> If yes, location and distance <br /> w - <br /> SAMPLING alarm C <br /> ocjcnJr <br /> Holding Temperature <br /> Method '° VI`s Pack <br /> Screening Method <br /> Tracking Sheet - {y/ n ) <br /> ft. wr fL <br /> SPOILS <br /> Storage Method MATERfALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) <br /> Storage Location Casing type y <br /> Blank ft. Screen ft. <br /> SIot 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 />