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r <br /> MONITORING WELL INSTALLATION REPORT <br /> CONSTRUCTION <br /> Total Depth <br /> Premise Address: �d�0 Screen Length (from) (ro) <br /> �W cf M c✓ �r Filter Pack (from) (to) <br /> Well No.: Bentonite (from) (co) <br /> / Grout (ham) (ro) <br /> Inspector. L �D Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/cltristie box (circle one) <br /> Drilling Company: <br /> ��� casing <br /> Driller: n -- ? height <br /> � � <br /> Consultant— _ <br /> Geologist A VE-GRCUND C-SZ Y30X <br /> OONV LETION CC+1tP LEMCN <br /> �.—Groom Suiact <br /> SPECIAL PERMIT INFO. <br /> prat <br /> Distance to sewer line— 30 . ft. <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - I.r ft <br /> a <br /> o <br /> C <br /> O <br /> SAMPLING t cic <br /> tocicn —_ <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n) = tt. <br /> ft. <br /> SPOILS <br /> MATERI ALS/DEVEI.OPMENT <br /> Storage Method <br /> Contamination Noted - (y/ n) Casing type �r�UU <br /> Storage Location Blank 1) fc. Screen <br /> Slot size U 6 2 d <br /> Bags cement <br /> GROUTING Buckets bcn[oni[e <br /> Bags sand/gmvel <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - (y/ n ) <br /> installation Method Discussed with geologist: - (y/ n) <br /> Quantity installed Type of method <br /> EH 29 29 <br />