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MONITORING WELL INSTALLATION REPORo <br /> AU EE�5 <br /> C-6 <br /> Date: CONSTRUCTION <br /> �I����� Total Depth � <br /> Premise Address: - Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> I(N(r)V Grout (from) (to) — <br /> Inspector: Dulling rig type -- <br /> Auger O.D. I.D. <br /> Permit No. \r Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: V �I <br /> M� casing <br /> Driller: height <br /> Consultant ,I(1G1N - T <br /> 7//,F6 <br /> Geologist IN uL � - AEgO -GRCUND <br /> CtStS'TY480X <br /> CC&PLETCN COWLnCN <br /> Ground Surface <br /> SPECIAL PERMIT INFO, tJ�Z <br /> QrocR <br /> Distance to sewer line Z <br /> Domestic well on site - (y/ n ) L <br /> L f <br /> If yes, location and distance - ' <br /> _ o <br /> a <br /> alc6d C <br /> SAMPLING <br /> socian <br /> > v': Pack <br /> Holding Temperature - <br /> ::� — <br /> Method ' <br /> Screening Method <br /> Tracking Sheet - ;n) <br /> ''ll// <br /> a <br /> SPOILS <br /> MATE UALS/DEVELOPMENT <br /> Storage Method — 0 <br /> Contamination Noted - (y/ n ) Casing type'_D� <br /> Storage Location Blank ft. Screen <br /> Slot size r) c77 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter pack type/size <br /> Mix Ratios Surge Block: - (Y/�)) <br /> Installation Method Discussed with geologist: - (Y/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />