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MONITORING WELL INSTALLATION REPORT <br /> aa 'syn <br /> Date: �I20 ^ O 1 CONSTRUCTION <br /> Premise Address: ls� -'^ "'`^" " Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. k9 Grout (from) (Co) <br /> Drilling rig type <br /> Auger O.D. LD. <br /> Permit No. Completion - Stove pipe/cltristie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: height <br /> ConsultAw <br /> Geologist • �V"t✓ ABOVE-GRCUND <br /> Cott L TION COhLNLETION <br /> Cr✓ nd Suint <br /> SPECIAL PERMIT INFO. <br /> prat <br /> Distance to sewer line ft. <br /> Domestic well on site - (y/ n) ft <br /> If yes, location and distance - <br /> _ = o <br /> = o <br /> SAMPLING tlarad = J <br /> soc cn — <br /> Holding Temperature <br /> Method <br /> Screening Method —_ <br /> Tracking Sheet - (y/n) <br /> ft. — <br /> SPOILS <br /> MATERIALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted - (y/ n) Cuing type f <br /> Storage Location Blank fc. Screen__ <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Bags sand/gavel <br /> Depth to water <br /> Filter Pack type/size �— <br /> Mik Ratios Surge Block: - (y/rt) <br /> dttstalladon Method Discussed with geologist: - (y/ n) <br /> Quandryinstalied Type of method <br /> EH 29 29 <br />