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MONITORING WELL INSTALLATION REPORT <br /> Date: b��71 �� CONSTRUCTION <br /> Premise Address: 7 S w• jc'-e— Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bento <br /> Inspector. ��I E Groutnite (from ) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant '9 <br /> Geologist <br /> ABOVE-GACUND <br /> COMPLETION ChRZTY-30X <br /> COMPt.ET1CN <br /> SPECIAL PERMIT INFO. G=rd S40acs <br /> Distance to sewer line Oran <br /> Domestic well on site - (y/ n ) 7 tt< <br /> If yes, location and distance - ft <br /> ft. <br /> w <br /> — o <br /> C <br /> SAMPLING = <br /> ilorai <br /> socicn — <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) R< <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen h. <br /> Slot size <br /> GRO[PCING Bags cement <br /> Buckets bentonite <br /> Depth.to water Bags sand/gravel <br /> Mix Rados 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 />