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I <br /> MONITORING WELL INSTALLATION REPORT <br /> I <br /> Date: �/ y�/� ' / / CONSTRUCTION <br /> � 1 <br /> V <br /> Premise Address: Ife/ - �G( lti, Z&Ao Total Depth <br /> 7 Screen Length (from) (to) <br /> Well No.: Filter Pack <br /> (from) (to) <br /> ��i„ Q� Bentonite (from) - (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling,Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: casing <br /> qq <br /> Consultant_ aJ&-kk height <br /> Geoleglst T <br /> ABOVE-GROUND <br /> COWPLETION CHRM Y-BOX <br /> SPECIAL PERMIT INFO. Sexy <br /> COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - ft. <br /> g <br /> e <br /> m <br /> C <br /> SAMPLING dcttad = 3 <br /> aacdon <br /> Holding Temperature = <br /> Method " = VIVW Pack <br /> Screening Method <br /> M c <br /> Tracking Sheet - (Y/ n) <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type_' "- Sol, ►' " <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> / r� Buckets bentonite <br /> Depth to water A6 -L T 3 ") 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 /> T <br />