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MONITORING WELL INSTALLATION REPORT <br /> Date:_ <br /> CONSTRUCTION <br /> Premise Address: ,( <br /> Total Depth 6 S <br /> Well No.: -Z Screen Length (from)_ X-C)T (to)�__ <br /> Filter Pack (from) L ' (to) <br /> Inspector. �e gra t Bentonite (from) + (to) _ <br /> Grout (from)__fi(to) <br /> Permit No. Drilling rig type -- -- <br /> Auger O.D. _ I.D. <br /> Drilling Company: Completion - Stove pipe/chrisde box (circle <br /> Driller._ <br /> Y_ casing <br /> Consultant height: <br /> TF77 <br /> Geologist YL. 0 / � <br /> AECVE GRCUND T <br /> SPECIAL PERMIT INFO. COWLETCN CFGM7Y30X <br /> Grwnd Suiaca T' <br /> Distance to sewer line <br /> Domestic well on site - ( n ) Gr«n <br /> If yes, location and ance - <br /> f t. <br /> SAMPUNG <br /> 1lornd <br /> Holding Temperaturej cR ve <br /> socicn 4 = 3 <br /> Method_ <br /> Screening method T--- = = pravdpadt <br /> Tracking Shcet - y n ) =w <br /> SPOILS O—�-it. <br /> Storage Method 55 <br /> Contamination Noted - y n) MATEWALS/DEVEI OPMENT <br /> Storage Location <br /> Casing type Z 11 PV C <br /> GROLMNG Bl,W fL Screen <br /> ow / <br /> Slot size —�-fr. <br /> Bags cement <br /> Depth to water _ Buckets bentonite I c <br /> Mix Ratios _ Bags sand/gravcl S <br /> Installation Metho �, Filter Pack type/size <br /> Quantity Installed w zC ` Surge Block: . —�-- <br /> Discussed with geolo tst: - (yCJ <br /> EH 29 29 Type of medtod L✓ <br /> �I <br />