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MONITORING WELL INSTALLATION REPORT <br /> Date: / �� 3_l = CONSTRUCTION <br /> Premise Address : Total Depth <br /> Screen Length (from) (to) <br /> Well No. : M W gtakl AF <br /> _ _ _ Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> ,Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. LD. <br /> Completion - Stove pipe/christie box (circle one) . <br /> . Drilling Company: <br /> Driller: „ r", - casing <br /> -- _r height - <br /> Consultant <br /> Geologist 4 �� W <br /> ���' � <br /> ABOVE-GROUND <br /> CONFECT ON CHRIST -aox <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surlace <br /> Distance to sewer line "Out _ <br /> Domestic well on site - ( y / n ) 1 <br /> If yes, location and distance - ft' <br /> _ ft. <br /> = m <br /> SAMPLING slotted = s <br /> sac5on — - <br /> Holding Temperature <br /> Method gr' P <br /> ack <br /> Screening Method = <br /> rs. _ <br /> Tracking Sheet - ( y / n ) _ p <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y / n ) <br />; Quantity Installed Discussed with geologist: - ( y / n ) <br /> Type of method <br /> EH 29 29 <br />