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MONITORING WELL INSTALLATION REP&4 <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: ��� Z Filter Park (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. Grout (from) (to) <br /> -E <br /> Drilling rig type roA 41 <br /> Permit No. Auger O.D._I f� . I.D. 1�13_r1 _ <br /> Completion- Stove pipe/chrisde box (circle one) <br /> Drilling Company: <br /> Driller casing <br /> 11MT <br /> height <br /> Consultant <br /> Geologist <br /> ABOVE ORCUND <br /> OOiVPLETiON COMPtETM <br /> SPECIAL-PR'=INFO, arcum Suriaes <br /> Distance to sewer line OrVA <br /> Domestic well on site-.(y/n) 4?(' - B. <br /> If yes, location and distance- 461 it. <br /> IM <br /> Cdr <br /> AMP abrwi = <br /> a <br /> Holding Temperature �[/ N = V11P** <br /> Method <br /> Screening Metho4_44Q — <br /> Tracking Sheet ry/n) = _ <br /> tL <br /> SPOILAS <br /> Storage Method MA'IERTALS/DEVEI.OPMF,N'i' <br /> Contamination Noted - (y/n) <br /> Storage Location- Casing <br /> BlankM:L_fL Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 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 />