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MONITORING WELL INSTALLATION REPORT <br /> r��s �` 2�.�►r.c�. w.e.�f <br /> Date: `' 710 CONSTRUCTION <br /> Premise Address: � f/6 A /&U t" � Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> p Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. 7, I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: casing <br /> height . <br /> Consultant —trw-T <br /> Geologist 7//,1' f <br /> ABOVE-GROUND <br /> COMPLETION CHRLM-BOX <br /> SPECIAL PERMIT INFO. Ground Stria COMPLETION <br /> at _ <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - ft. <br /> = m <br /> _ a <br /> SAMPLING <br /> _ o <br /> slotted <br /> soadon "— <br /> Holding Temperature <br /> Method __ v'ys,Pack <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 <br /> Blank ft. 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 />