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MONITOItiNG WELL INSTALLATION REPORT <br /> ON <br /> Dater 2;1 —CONEMM <br /> -� <br /> ��(� �� TOW Depth <br /> premise Address: Screen Length (froth) (to)Fiilter Pack Morn) (to} <br /> Well No.: A'Lr✓ _ Bentonite (from) (to) <br /> Grout. <br /> (from), (to) <br /> Inspector. Drilling rig type <br /> Auger O.D. I.D. <br /> PermitN°• Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> ,. casing <br /> Driller•. - height <br /> Consultant <br /> CuAlo$lsst b� ABOVE-GACOND -BOX <br /> COMFLETION COMPL_TION <br /> ' emnd Surface <br /> SEACIAL U&M INFO <br /> grout <br /> Distance to sewer line t!• <br /> Domestic Well.on site.- (y/n) <br /> If yes,location and distance - ft' <br /> Ar <br /> Holding Temperature <br /> Method = <br /> screening Method . '- <br /> Tracking Sheet - (y/n) ' <br /> NT <br /> Storage Method MATEPJALS/DEVELg ME <br /> Contamination Noted- {y/n) Casing type <br /> Storage Location Blank ft. Screen ft• <br /> Slot size <br /> Bags cement <br /> GRp NG Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Rados Filter Pack typesize <br /> Insta!ladon Meth Surge Block:- (y/n) <br /> Quantity installed Discussed with geologist: - (y/n) <br /> 'type of method <br /> EH 29 29 <br />