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MONITORING WELL INSTALLATION REPORT <br /> L b I r4l b 1 CONS ON <br /> Date: � <br /> "k Total Depth LIS <br /> Premise Address: Screen Length (from) Cto)_ <br /> /y� w Filter Pack (from) Cto)—yam <br /> 112 <br /> Well No.: Bentonite (from) (CO) <br /> �y l star Grout, (from) (to) <br /> Inspector-, I l Drilling rig type_ -alp ,. at 4 ri1 <br /> —� Auger C.D. <br /> Permit No. Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company*. <br /> casing <br /> Driller: I I hzi5h[ <br /> .Consultant <br /> Geologist A°!W&GRCUND CkG27Y-Bax <br /> COWL DfON c*NtPLEIICN <br /> C rwr�Susan T <br /> SPECIAL PERMIT INFO. <br /> prwt <br /> Distance to sewer line L(O II <br /> Domestic well on site - C y <br /> If yes, location and distance - <br /> vti G <br /> O <br /> C <br /> SAMPLING sacicn <br /> Holding Temperature---------- = F <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n) j <br /> v �� _ b ft. <br /> n. <br /> SPOILS <br /> MATERIALS/DEVELOPMENT <br /> Storage Method 11 r) <br /> Contamination Noted - (y/ n) Casing type r v ft. <br /> Storage Location Blank fc Screen /�� <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gravcl <br /> Depth to water. Filter Pack type/size <br /> Mix Rados Surge Block: - (y/ n) <br /> dpstallation Method Discussed vrith geologist: - (y/n) <br /> Qua ntity Installed Type of method <br /> EH 49 29 <br />