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MONITORING WELL INSTALLATION REPORT <br /> Date: t a 1 CONSMUCITON <br /> Premise Address: Tota! Depth___ <br /> Screen Length (from) 4 0D�--�- <br /> Well Na.: lJU - �" Filter Pack (from) -(to) <br /> Bentonite (from)_ Lf <br /> Inspector: Grout (from) <br /> Drilling rig type <br /> Permit No. Auger Q.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> L- )�st"ti.y , <br /> Driller. <br /> height <br /> height <br /> Consultant tY V <br /> 7 M <br /> Geologist 'J <br /> ABOVE-GACUND G WSST1'-30X <br /> COWPL.ETCN �t_mCN <br /> SPECIAL PERMIT INFO. Ghurd gulycy <br /> Distance to sewer line grout <br /> Domestic well on si - (y/ n ) y ft. <br /> If yes, location distance - <br /> i <br /> M <br /> SAMPLING <br /> sac-icn <br /> Holding Temperre r _ <br /> Method <br /> Scree ; Method <br /> Tracking Shcet - (y/ n ) <br /> a, <br /> SPOILS <br /> Storage Metho MATERIALS/DEVELOPMENT <br /> Contamina ' n No - (y/ n <br /> Storage L cation Casing type Zy <br /> Blank fr. Screen <br /> Slot size o t <br /> GROUTING Bags cemenr <br /> Buckets bentonite, <br /> Depth to water 2 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size A f h a2n&,.,Z <br /> Installation Methodn �'j�r�ma �e vinn-L� Surge Block: -ky)/ ti ) <br /> Quantity Installed - L] Discussed with geologist: (y/ n ) <br /> Type of method <br /> EH 29 29 <br />