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MONITORING WELL INSTALLATION REPORT <br /> CONSTRUCTION <br /> Date: <br /> /l�� <br /> Premise Address: Total DepthScreen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> 1��(� . Grout (from) (to) <br /> Inspector. L\ Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller- height <br /> LJi11w-,� �-u-o � '0' <br /> Consultant G, VT��'`'« Ajo-v&GRCUND <br /> C1_R;STY-30X <br /> CO wp L.R C N GOMPL_='nCN <br /> Grand S�xlacs <br /> SPECIAL PERIvtIT INFO. <br /> groc.Z <br /> Distance to sewer line ft• <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - h <br /> i• Z: <br /> o <br /> SAMPLING toczcn <br /> Holding Temperature = Y� <br /> Method <br /> Screening Method =' = <br /> Tracking Sheet - ( y/ n ) = ft. <br /> SPOILS <br /> MATERIALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted - (y/ n ) Casing type <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/ 11 ) <br /> Installation Method Discussed with geologist: - (y/ n ) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />