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MONITORING WELL INSTALLATION REPORT <br /> Date: c IOU �_ CONSTRUCTION I <br /> Premise Address: 5 L., �� � Total <br /> lepth <br /> 'i screen ngth (from)--7L—(to) <br /> Well No.:�]l% Z +�" I � /YID✓ Filter Pack (from) ' Ro) <br /> ff Bentonite (from) (to) <br /> Inspector, t I K"�p' ` Grout (from) (to) <br /> f I, j Drilling rig type <br /> Permit No. MA L�xXa?m Auger O.D. I I.D. <br /> Completion - Stove ipe/christie box (circle one) <br /> Drilling Company: <br /> c sing <br /> Driller: � _ght <br /> Consultant 11T <br /> I„LC.� �C ,� <br /> Gealogist (� A8CV -GROUND ChRiSTY-30X <br /> COMPLETION C MPL�TION <br /> SPECIAL PERMIT INFO. <br /> prwt <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n) tt• <br /> if yes, location and distance - ft. <br /> tt. <br /> 0 <br /> SAMPLING tJJ{Xs ^ slorai <br /> t A socicn r _ <br /> Holding Temperature <br /> Method _ <br /> Screening Method <br /> Tracking Shcet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) /I <br /> Storage Location Casing type ft <br /> Blank ft,' Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite / — <br /> Depth to water i '{' Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installadon Method Surge Block: - ( / n ) <br /> Quantity installed Discussed with cologist: - (y/ n ) <br /> Type of metho <br /> EH 29 29 <br />