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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth 0 <br /> Screen Length (from) 0 (to) <br /> Well No.: Filter Pack (from) a (to) <br /> Bentonite (from) I (to) 142 <br /> inspector. Gr (fr <br /> Dr9l' p <br /> Permit No. Auger O.D. V+ I.D. V14 <br /> Completion - Stove pipe/Christie box (circle one) <br /> Drilling Company: <br /> Driller: - �� casing <br /> height <br /> Consultant V ` <br /> Geologist APAVE,GRCUNC) CF�` <br /> CONVL TION OOMPLE-ICN <br /> COt,4'L'TICN <br /> SPECIAL PERMIT INFO. S <br /> grat <br /> Distance to sewer line <br /> Domestic well on site - C y/ n) 1b - ((, <br /> If yes, location and distance - 1$ ft. <br /> Zo ft. x — <br /> 0 <br /> c <br /> 0 <br /> SAMPLING ilorai <br /> secicn - <br /> Holding Temperature _ _ pard haat <br /> Method _ <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> ft. —' tt• <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) Casing tYPe tt YG PVL <br /> Storage Location f <br /> Blank 2.o fr. Screen P_6 <br /> Slot size 0.0z0 <br /> GROUTING Bags cement '�;- <br /> Buckets bentonite <br /> Depth to water ✓ ZZ "Z`E Bagssand/gravel /Uo <br /> Mix Rados A -�� ew . Fater Pack type/size tfi <br /> dttstallation Method Surge Block: - (y/n <br /> nstall tion ailed SU Discussed with geologist•, - (6)1 nQuanti ) <br /> Type of method <br /> EH 29 29. . <br />