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MONITORING WELL INSTAILATION REPORT <br /> Date:­­:,'',!, CONSTRUCTION <br /> -W�'t1, L�/v Total Depth <br /> Premise Address: Screen Length (from) (to) <br /> n Filter Pack (from) (to) <br /> Well No.: Bentonite (from) (to) <br /> Inspector. + Grout (from) (to) <br /> 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: 7— height <br /> Consultan <br /> Geologist KGVE-GRCUN0 C11-GZTY,30X <br /> CO W L.`T C N CpMPt-'TICN <br /> C3rzund Su�ixs <br /> SPECIAL PERMIT INFO. <br /> gro rt <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - ft' <br /> ft. { <br /> V' M <br /> A � <br /> - C <br /> SAMPLING — <br /> socicn — <br /> B <br /> Holding Temperature —_ <br /> Method <br /> Screening Method — <br /> Tracking Sheet - ( y/ n ) _ <br /> -"b 5f <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) ��`/� /� <br /> Casing type <br /> Storage Location Blank_ -��.ft- Screen Zo ft, <br /> Slot size t) nl V <br /> GROUTING Bags cement <br /> Buckets bentonite - <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 21/ 2-- <br /> Installation Method Surge Block: - y�/ 31 ) <br /> Quantity Installed Discussed with eologist: - 61 n ) <br /> Type of method <br /> EH 29 29 <br />