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MONITORING WELL.INSTALLATION REPORT <br /> Dater Z CONSTRUCTION <br /> Premise Address: 0 5� Total Depth <br /> Screen Length (from) (to) <br /> Well No.: �` f`J 2 Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. Grout (from) (to) <br /> P Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: _ height <br /> Consultant <br /> Geologist AE, -GROUND Sn•-30X <br /> COMPLETION co&tot-mCN <br /> Gird sLsfxs <br /> SPECIAL PERMIT INFO. <br /> prcut <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) ft. <br /> if yes, location and distance - ft• <br /> ft. <br /> i M <br /> O <br /> SAMPLING iloroi 's; <br /> socicn <br /> Holding Temperature — <br /> pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> Storage Method ��^- '' ' MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( / ) <br /> Casing type <br /> Storage Location ft <br /> gl� ft. Screen <br /> Slot sizel7 c,Z u <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pack type/size s a <br /> Mix Ratios Surge Block: - (y/45zi1 <br /> -\Installation Method Discussed Yrith geost: - (l% n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />