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•MONITORING WELL INSTALLATION REPT <br /> Date: �� CONSTRUCTION <br /> r7 n,�,.� <br /> Premise Address: I 07 '/ Total Depth l) <br /> Screen Length (from) (to) <br /> Well No.: ��/� Filter Pack (from) (to) <br /> U O p Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig typ <br /> 52 Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: height <br /> Consultant R «^- WT <br /> Geologist s �� ABOVE-GROUND CHRST'Y-S0X <br /> COh'1PLETCN COMPLETION <br /> C3tound Surfaee <br /> SPECIAL PERMIT INFO. <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) tt' <br /> If yes, location and distance - tt' <br /> n. <br /> = m <br /> — o <br /> SAMPLING slotted _ 8 <br /> section —_ <br /> Holding Temperature <br /> Method = <br /> Screening Method = <br /> Tracking Sheet - (y/ n) _ <br /> SPOILS <br /> MATERIALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted - (y/ n ) Casing type <br /> Storage Location Blank $. — Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water '�9 U 1 Filter Pack type/size <br /> Mix Ratios Surge Block: - (y/ ) <br /> Installation Method Discussed with geol gist: - ( y/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />