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MONITORING WELL INSTALLATION REPORT <br /> CONSTRUCTION <br /> Date: L / <br /> / %61 Total Depth <br /> Premise Address : ilu Screen Length (from) (to) <br /> Filter Pack (from) (to) <br /> Well No .: Bentonite (from) (to) <br /> Grout (from) (to) <br /> Inspector•. Drilling rig type <br /> Augcr O.D. _ I.D. <br /> Permit No. Completion • Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> ^ � casing <br /> Driller I I height <br /> Consultant <br /> Geologist ABOVE-GRCUND CtiRZTYIBOX <br /> cowLEDON COMPLEMN <br /> C;rwnd Sulan <br /> SPECIAL PERMIT INFO. <br /> prCut <br /> Distance to sewer line _ It. <br /> Domestic well on site • ( y / n ) ft. <br /> If yes, location and distance - tt <br /> _ <br /> tlonod � � <br /> SAMPLING socicn <br /> tr+v°I Facie <br /> Holding Temperature := <br /> Method = <br /> Screening Method <br /> Tracking Sheet • ( y <br /> h. <br /> SPOILS <br /> MATERIALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted - ( y / n ) Casing type <br /> Storage Location Blank ft. Sueen��tt' <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water. Filter Pack type/size <br /> Mix Ratios Surge Block: - ( y / tt ) <br /> dpstallation MethodwwwwwwwwwwwwwwwwwDiscussed with geologist: - ( y / n ) <br /> Quantity installed Type of method <br /> EH 29 29 <br />