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U <br /> is MONITORING WELL INSTAI.3.P►TiON REPORT <br /> CONST <br /> Date, <br /> Total Depth <br /> Premise Address: Screen Length (from) (Co) <br /> „ Filter Pack (from) �' (to) <br /> Well No.: YW I� (to) c <br /> Bentonite Efrom) <br /> Grout (from) (to) <br /> Inspector. ,= ^"�`�4 Drilling rig e <br /> ° r Auger.O.D. • 1.D. L <br /> Permit No. Completion - Stove pipe/cltristie box (circle one) <br /> Drilling Company: <br /> Y" casing <br /> Driller i height <br /> Consultant <br /> 'r <br /> Geologist t--- C ' /1E01lI;:-Gq Np• Ck�tGST'f X <br /> GCl�iPLETfON CN <br /> G =rd 5t:ixs r <br /> SPECIAL PERMIT'INFO. <br /> prccst <br /> Distance to server line <br /> Domestic well on site - (y/ n) ft. <br /> if yes, location and distance <br /> .Y, p <br /> O <br /> SAMPLING 9 'cn <br /> Holding Terri5erature vC) <br /> Method +" _ <br /> Screening Method <br /> Tracking Sheet <br /> it. <br /> SPOILS <br /> MATERIALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted - y n) Casing e pfv <br /> Storage Location Blank .ft. Screen ft. <br /> Slot size o.o-t G <br /> Bags cement <br /> GR_ OUTING Buckets bentonite <br /> �b �S Bags sand/gravel <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - (y/11 ) <br /> installation Method Discussed with geologist: - / n } <br /> Quantity installed Type"of method <br /> EH 29 29 <br />