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MONITORING WELL INSTALLATION REPORT <br /> Date: ��,�2 �s G CONSTRUCTION <br /> Premise Address:_ Total Depth <br /> Screen Length (from) ` (to)_ <br /> Well No.: 1! ��.'_ 1 I� Filter Pack (from) 7 (to) V <br /> Bentonite (from) - (to)— --- <br /> Inspector: _ i­�-tA'ty„ „yn Grout (from) (to) <br /> Drilling rig type <br /> Permit No. `j Mr> Zj I Auger O.D. LD. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> `�',L <br /> ` , etc= < <br /> Driller:_ :(;;� casing <br /> height <br /> Consultant <br /> Geologist C KI ._ T <br /> ABOVE-GROUND <br /> CCNFLETICN CHRSTY-SOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface - ���. <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - -3---- - <br /> 1 ft. <br /> ft. <br /> = m <br /> q <br /> C <br /> SAMPLING = ° <br /> t to tied � <br /> taction <br /> Holding Temperature <br /> Method _ V"VSl Pack <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method i V\ MATERIALS/DEVELOPMENT <br /> Contamination Noted - Q/ n ) <br /> Storage Location_ cy tit s Casing type <br /> Blank4 ft. Screen i t' ft. <br /> Slot size r; I r <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size z !G <br /> Installation Method „ Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />