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MONITORING WELL INSTALLATION REPORT <br /> Date: jq d CONSTRUCTION <br /> Premise Address: Total Depth �S� ��bs <br /> Screen Length (from) <br /> Well No.- V Filter Pack (from) /w (to);F <br /> /� Bentonite (from) (to) <br /> Inspector; l Grout (fr om) (to) <br /> Drilling rig tykJ <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: ",1-A /o <br /> Completion - Stove pipe/christie box (circle one) <br /> ��-� <br /> Driller: casing <br /> I- <br /> height <br /> Consultant C 2�i <br /> Geologist li�p—' b ak 7 <br /> ABOVE-GROUND <br /> COMPLETION C4-{RZTY-8OX <br /> SPECIAL PERMIT INFO. pend Suaiaos COMPLETION <br /> Distance to sewer line Grp <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft• <br /> ft. ft. <br /> = m <br /> — m <br /> — c <br /> SAMPLING _lo ttad <br /> �J(Ti»7'� suction — <br /> Holding Temperature NjA <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) - — <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type.621S Atw �JCi <br /> Blank ft. Screen /U ft. <br /> Slot size O b 1 U <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water S Bags sand/gravel- Z ji L <br /> Mix Ratios Filter Pack type/size <br /> Installation Method--6c2A, , C Surge Block: - (y/ n) <br /> Quantity Installed Discussed with geologist: - ()Y/ n) <br /> EH 29 29 Type of method <br />