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f- <br /> MONITORING WELL INSTAUd.ATION REPORT <br /> �� CONSTRUCTION <br /> Date: <br /> � Total Depth • (to)_ <br /> Address: Screen Length (from) <br /> Filter Pack (from) (to) _ <br /> Well No.: Bentonite (from) (to) <br /> Grout (from) (to)_ <br /> Inspector" <br /> to) — <br /> InspectorDrilling 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: he?ght <br /> Consultant <br /> Geologist AvoVE-GFtcUND C4,S:M-box <br /> COWLEMN CONL UTICN <br /> --Grcund Suiacs <br /> SPECIAL PERMIT INFO. <br /> Q f CX.'t <br /> Distance to sever line <br /> Domestic well on site .- (y/ n) ft. <br /> If yes, location and distance - -ft — <br /> - O <br /> iloC.a.1 p <br /> SAMPLING <br /> .r = �xvvi F.aGt <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/n V 7� tt. <br /> SPOILS <br /> MATERIALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted- (y/ n) Casing type ft <br /> Storage Location Blank ft. Screen <br /> Slot size <br /> Bags cement <br /> G _ROUTING Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - (y/n ) <br /> �stallation Method Discussed vrith geologist: - (y/ n) <br /> d <br /> Quantity Installed Type of method <br /> EH 29 29 <br />