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MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> 2A CONSTRUCTION <br /> " ..� Total Depth <br /> Premise Address: Screen Length (from) (to) <br /> Filter Pack (from) (to) _ <br /> Well No.: Bentonite (from) (Eo)- <br /> Grout <br /> to) - <br /> Grout (from) (to) <br /> Inspector. +^-^�'�� Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller• height <br /> f6• - '9' <br /> Consultant <br /> —Qv±� <br /> Geologist ��� � ChRIST`l-30x <br /> CD MSP LETSON COWILEMCN <br /> C�ouc�d Suixs <br /> SPECIAL PERMIT INFO. <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) P. <br /> If yes, location and distance - 4-7 <br /> C <br /> O <br /> SAMPLING socicn —_ <br /> •/, �. 1nyv;__c <br /> Holding Temperature = �� <br /> Method s <br /> Screenino Method <br /> Tracking Shcet - (Y/ n) L '• .— tt. <br /> n <br /> SPOILS <br /> MATERI ALS/DEyEi.OPMENT <br /> Storage Method <br /> Contamination Noted - (y/n) Casing type fr <br /> Storage Location gl fc. Screen <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - (y/n) <br /> installation Method Discussed vrith geologist: - (Y/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />