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J MOMTORING WELL INSTP.UAMON REPORT <br /> CONSTRUM1 ON <br /> Date: <br /> Total Depth {[o) <br /> Premise Address: Screen Length (from) (ta)_ <br /> Filter Pack (from) (to)_ <br /> Well No.: Bentonite (from) <br /> Grout (from) <br /> Inspector. Drilling rig type I.D. <br /> Auger O.D. <br /> Permit No. Completion Scove pipe/chl istie box, (circle one) <br /> Drilling Cotnpany: <br /> cas:nq <br /> Driller- he+ght <br /> Consultant <br /> ABOVE-Gr'ICUND Gr►RSTY-aox <br /> Geologist Cc)kpLRpN COMPLmON <br /> Cxx:r�S�xtac-s <br /> SPECIAL.PE"T INFO. QCCK t <br /> Distance to sewer line <br /> Domestic well on site = (Y <br /> If yes,location and distance - <br /> 0 <br /> C <br /> O <br /> s6WU_N G so-cicn <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (Y/n) ��, <br /> SP_ILS_ MA'TEWALS M .OPMENT <br /> Storage Method <br /> Contamination Noted- (Y/ n) Casing type <br /> BlScretn <br /> Storage Location ank ft. <br /> Slot site <br /> Bags cement <br /> GRpUnNG Buckets bentonite <br /> Bags sartd/gTa�el <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - (Y/n) <br /> stallation Method Discussed with geologist: - (Y/n) <br /> Quantity Installed Type aE method <br /> EH 29 29 <br />