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()MONITORING WELL INSTALLATION REPT <br /> Date: D 'CONSTRUCTION -- <br /> Premise Address: d "'q W� �n�.�,,— L.� Total Depth <br /> Screen Length (from) (to) <br /> Well No.: U`) `~ 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/clu-istie box (circle one) <br /> Drilling Company: <br /> Driller: casiiiq <br /> height <br /> Consultant <br /> Geologist <br /> ABOVEGROUND CHRSM4= <br /> COMPLfiTnN COMPLETICN <br /> SPECIAL PERMIT INFO, Ground Surface <br /> .a <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) ft. <br /> jf yes, location and distance - ft- <br /> SAMPLING sloro.i = <br /> (Pc <br /> Holding Temperature <br /> iQCZGA ' <br /> Method ILA _ 9M pack <br /> •'X <br /> Screening Method µ <br /> Tracking Sheet - ( n } - <br /> SPOTLS <br /> Storage Method MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> Blank k Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Finer 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 />