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—_ -_-- - -- MONITORING WEii,1NSTALLATION REPORT <br /> Date: ! 0 <br /> CONSTRUCTION <br /> Premise Address: <br /> Total Depth <br /> Well No.-' Screen Length (From)_ <br /> Filter Pack <br /> (from) �� �tO) <br /> Inspector: Bentonite Vrorn) to). <br /> Grout (front) <br /> Permit No. Drilling rig type <br /> Auger O.D. I.D. �~ <br /> Drilling Company; Completion - Stove pipe/ch istie xb ^� <br /> ,off n� <br /> Driller'r <br /> caoLng. <br /> Consultant 0VA'Vei heighh <br /> Geologist <br /> ` <br /> ABOVE-GRCUND <br /> OQMPLETION C�ARSTY-BOX <br /> SPECIAL PERMIT INFO. COMPLE"ON <br /> • <br /> Ground St,zixs <br /> Distance to sewer line <br /> Domestic well an site.- (y/n) <br /> If yes, Iocation and distance <br /> .' E2 .. <br /> SAMPLING slorod <br /> I — <br /> Holding Temperature <br /> Method :¢ 72 r <br /> Screening Method ' <br /> Tracking Sheet (y/ n } <br /> ti! <br /> Storage Method MATERIALS EVELOPMENT <br /> Cont4mination Noted - (y/n) <br /> Storage Location Casing type . <br /> Blank ft. Screen �• <br /> • Slot size <br /> G- ROI.TIZNG Bags cement <br /> Buckets bentonite <br /> Depth to water Flags sand/gravel <br /> Mik Rados Filter Pack type/size <br /> installation Method Surge Block: - (y/n ) <br /> Quantity Instalied Discussed with geologist: - (y/n ) <br /> Type of method <br /> EH 29 29 <br />