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0 9 <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: j I `cI CONSTRUCTION <br /> Premise Address: T� Total Depth <br /> (�✓ Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle <br /> Driller: casing <br /> height <br /> Coniultant 74 6 <br /> Gee�st � (LI <br /> ABOVE-GROUND <br /> CO&FLETION CHRMT'-BOX <br /> SPECIAL PERMIT INFO. COMPLETION <br /> �-�-� drour�urlaca <br /> Distance to sewer line, 'rail <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - .��ft, <br /> IS ft. ft' <br /> m <br /> SAMPLING <br /> Holding Temperature <br /> Method <br /> s> = 9ravel�9aat(" � <br /> Screening Method c <br /> Tracking Sheet - (y/n ) <br /> tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> 1 Buckets bentonite <br /> Depth water d:n Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n—) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> EH 29 29 Type of method <br />