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MONITORING WELL INSTALLATION REPORT <br /> Date: S -i'le, CONSTRUCnoN <br /> Premise Address: 2 Total Depth Z1 tn�^�� RAW-q M• <br /> Well No.: a Screen Length (from) <br /> Fflter Pack (from) tj ' (to) E <br /> Inspector. <br /> Bentonite (from) -- —(to)�Y <br /> Grout (from) (to)`��_ <br /> Permit No. Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company: x Completion - Stove pipe/clu-isde box (circle one) • <br /> Driller. <br /> �.� caning <br /> Consultant [© '4 height <br /> Geologist <br /> ABCVE-GRCUND <br /> C0hVL,=T10N �LSTY-aox <br /> SPECIAL PERMIT INFO. COF.LmCN <br /> c3roc:nd Syriac-t <br /> Distance to sever line <br /> Domestic well on site - <br /> (y/n } <br /> Ii yes, location and distan <br /> o <br /> SAMPIJNG <br /> 110rod c <br /> Holding Temperature +adcn <br /> Method VnVW Pack <br /> Screening Method -" <br /> Tracking Sheet - n <br /> SPOILS <br /> Storage Method S - �✓1 { <br /> Contamination Noted - /n } MATERIALS EVEI,OPMENT <br /> Storage LocationCasin, <br /> Blank type <br /> .� wv�P�►ne Jr- Screen fr. <br /> GR�ouncGG Slot sue ,OZ-0 <br /> Bags cement <br /> Depth to water v( �`. Buckets bentonite <br /> Mix Ratios Bags sand/gravel <br /> installation Method Filter Pack type/size <br /> Quantity insralIed Surge Block: - (y <br /> Discussed with geologist: - (y,� <br /> EH 29 29 Type of method <br />