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MONITORING WELL INSTALLATION REPORT <br /> Date: z o CONSTRUCTION <br /> � i <br /> Premise Address:_ Total Depth �S <br /> Screen Length (From) <br /> Well No.: - Filter Pack (from) 37-�-- <br /> Bentonite (from) <br /> Inspector. Xn�(to)�— <br /> Grout (from) $ (to) moo' S <br /> a Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/chrisde box (circle one) <br /> Driller: Ov casing <br /> Consultant <br /> '9 height <br /> Geologist "� <br /> J4�,CYE-Gr�G`(.fND <br /> 00FRLE7CN C1HR*TY-a0X <br /> SPECIAL PERMIT INFO cam- ncN <br /> ' C3rwrx3 S+.riac* <br /> Distance to sewer line Oran <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance <br /> - a <br /> 4" m <br /> SAMPLING <br /> �_ o <br /> :Jorai :: c <br /> Holding Temperatvxe <br /> Method " pavvIpadc <br /> Screening Method <br /> Tracking Sheet o/ n ) <br /> SPOILS <br /> Storage Method 1;-S C14 dALt-, MATERIALS EVEt,OPMENT <br /> Contamination Noted - (y/(�)) <br /> Storage Location (,V- Casing type 2-"P V <br /> Blank t{ S—ft. Screen ft, <br /> GROUHNIG Slot size0 - 0-2-0 <br /> Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel - <br /> Mix Ratios Filter Pack type/size_ <br /> Installation Method C Surge Block: - (&Y n ) <br /> Quantity Installed n1 Discussed with geologist: - ( y <br /> EH 29 29 Type of method <br />