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MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> CONSTRUCTION <br /> Premise Address: , ' <br /> Total Depth <br /> Well No.: - -x W 7- Screen Length (from)__- (to) r= <br /> Filtet Pack (from)- 3:1 _(to)—LO-L _ <br /> Inspector: _ J•y Bentonite (from)_ <br /> Grout <br /> (from)_ �. (to) <br /> � <br /> Drilling rig O <br /> Auger O.D._ I.D,__ y. <br /> Drilling Company: nno. Completion- Stove pipe/christie box (circle one) <br /> Drilled: <br /> casing <br /> Consultant <br /> height <br /> Geologist <br /> ABO VE-G A OUND <br /> coYFLET{ON CHRM-Sox <br /> SPECIAL PERMIT INFO COMPLETION <br /> C3round Surfxw <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) I <br /> If yes, location and distance - <br /> C <br /> SAMPLING = s <br /> s to ttad r: <br /> • axion — • <br /> Holding Temperature = P <br /> Method = <br /> Screening Method 'r = <br /> Tracking Sheet (y/n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing typed c_ <br /> BlankftScreen S ft. <br /> GROUTING Slot size �Q r p <br /> l Bags cement <br /> 1 J Buckets bentonite <br /> Depth to water- v, Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method �_- <br /> ......-_ - .----- (.y_/_n_) <br /> Quantity Inst_alled Discussed with geologist: - (y/ n) <br /> EH 29 29 Type of method <br />