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MONITORING WELL INSTALLATION REPORT <br /> Date:�a� i n CONSTRUCTION <br /> Premise Address:_ ?YN? �_ �_�{ �t <br /> Total Depth <br /> { Screen Length (from)Well No.: eA� •N `1 ; ; <br /> Filter _(to) <br /> Pack (from)_ (to) 3 3 <br /> Bentonite (from) (to)__ <br /> Inspector: � _ Grout <br /> (from) (to)__ <br /> Permit No.: 00 l 7 DrillAuger10.D.g rig typeI.D. <br /> Drilling Company:_ s.(� Completion - Stove pipe/christie box (circle one) <br /> Driller:I,c._�'r _ <br /> TT casing <br /> height <br /> Consultant �� v - ��c✓s.{ <br /> Geologist 7F <br /> ABOVE-GROUND <br /> COWPLETlON CHRZ'Y-80X <br /> SPECIAL PERMIT INFO COMPLETION <br /> Ground Surf acs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - <br /> - <br /> "yY.. <br /> SAMPLINGQ = o <br /> ` p •totted ..° <br /> sac�on = <br /> Holding Tempera/e <br /> Method _ v&YW pack <br /> Screening Meth d ; _ <br /> Tracking Shee - (y/ n} — <br /> �_ft. <br /> SPOILS <br /> Storage Method 6 MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n <br /> Storage Location Casing type ��tl��� <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water J Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed �Z ' Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br /> 1 <br />