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MONITORING WELL INSTALLATION REPORT <br /> Date: ff i it)� CONSTRUCTION <br /> �� S- <br /> Premise Address: 'ce.r bTotal.Depth <br /> Screen Length'(from)' (to) <br /> Well No.: Filter Pack (from) (to) <br /> r/ Bentonite -(from) (to) <br /> inspector: Grout. (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. ISD. <br /> Completion- Stove pipe/christie box (circle one) <br /> Dig Company: 'l. <br />` Driller: casing <br />. n1""�� v� � height . . <br /> Consultant 6� !"7 "" T <br /> Geologist •� - r <br /> ABOVE-GROUND CHR6STY-80X <br />: 006 PLETION <br />� CQMPtETIOI�! <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - <br /> v � <br /> a.< e <br /> SAMPLING =lotted w <br /> d sacdon <br /> Holding Temperature, S _ tlmvw Pack <br /> Method _ <br /> Screening Method <br /> Tracking Sheet - (y/n ). n <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_1iy 1356- 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 /> .r <br />