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N <br /> MONITORING WELL INSTALLATION REPORT <br /> i <br /> CONSSTRUC ION <br /> Date: <br /> slS+�t Total Depth <br /> Premise Address: a Screen Length (from) (to) <br /> Filter Pack (from) (to) <br /> Well No .: Bentonite (from) (t°) <br /> Grout (from) (to) <br /> j Inspector. Drilling rig type <br /> Auger O.D .�— <br /> Permit No. Completion - Stove pipe/duzs[ie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: I I he ; <br /> \ <br /> C°RSu1CdRC <br /> Geologist A.,OVE-GRCQND C}4RSIY-30X <br /> COhvLET ON CCMPL—TICN <br /> I __ Ocwnd Stzlxa <br /> SPECIAL PERMIT INFO. Gf Cut <br /> Distance to sewer line — (t, <br /> Domestic well on site - ( y / n ) fL <br /> If yes, location and distance - ft - <br /> - = a <br /> = c <br /> SAMPLING soc cn = <br /> _ rrrard Faac <br /> Holding Temperature <br /> Method t- — <br /> Screening Method <br /> Tracking Sheet - ( y / n ) ft = tt. <br /> SPOILS <br /> MATERI ALS/DEVELOPMENC <br /> Storage Method <br /> Contamination Noted - ( y / n ) Casing type K. <br /> Storage Location Blank fr_ Screen <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 / n ) <br /> dpstallation Method Discussed vrith geologist: - ( y / n ) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />