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'MONITORING WELL INSTALLATION REPOR!" <br /> Date: CONSTRUCTION <br /> Premise Address.. Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> p Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casino; <br /> height <br /> Consultant V <br /> F17 <br /> Geologist._ <br /> A VE-Gr7Ct.1ND C+S* Y-30X <br /> C0h9LZr1CN COMPLEMCN <br /> SPECIAL PERMIT INFO, Saxfxa <br /> Distance to sewer line oEOtK <br /> Domestic well on site - (y/ n ) ft. <br /> Ii yes, location and distance - It- <br /> y'� O <br /> M <br /> iM1 <br /> SAMPLING <br /> alor" C <br /> Holding Temperature— _ — 91 Pack <br /> Method <br /> Screening Method — <br /> Tracking Shcet - ( y/ n ) <br /> SPOILS <br /> Storage Method MATERIL§ZDEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen h. <br /> Slot size <br /> GRO 'I"NG Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios I+iIter Pack type/size <br /> Installation Method Surge Block: - ( y/ ii ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />