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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION/� /'. / <br /> Premise Address:_ S7 5—(r,��,,� w Total Depth (sCy� <br /> Screen Length (from) (to) <br /> Well No.: [ v '-ILSwAy Filter Pack (from) (to) <br /> Bentonite (from)—(to)— <br /> Inspector: <br /> from) (to)Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No.... U Auger O.D. I.D. <br /> '(_er.[. /� Completion - Stove pipe/christie box (circle one) <br /> gCompany: <br /> Driller: casing <br /> height <br /> Consultant G�2. <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION CtIALM43OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line Cry <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - n• <br /> n. <br /> n. <br /> _= m <br /> Y <br /> 0 <br /> C <br /> SAMPLING = <br /> slotted _ <br /> vection — <br /> Holding Temperature C/ <br /> Method V,9 = 9' P <br /> Screening Method H. —_ <br /> Tracking Sheet <br /> n. _ n. <br /> SPOILS <br /> Storage Method �c�`^e r MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n Q /�J „ 1�� <br /> Storage Location-A 0 C j'J`�, t-�'`''''G"a's`mg typesr,I i <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> i Buckets bentonite <br /> Depth to water_ Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />