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,`. <br /> MONITORING WELL INSTALLA'iI REPORT <br /> SS ` <br /> • � � � 1 �u � bt] <br /> e _ CONSTRUCTION <br /> Date: �. n N 136 <br /> C c,7/� w ,�(I „Cyy� Total Depth <br /> Premise Addrjes�s: Screen Length (from) (to)_ <br /> Well No.: `J Filter Pack (from) (to) <br /> p Bentonite (from) (to) <br /> Inspector. "" � Grout Urorn) (to) <br /> Drilling rig <br /> Auger O.D. I.D. <br /> 16 <br /> Permit No. Completion - S ove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller he, <br /> Consultant <br /> Geologist A OVE-GRCUND GtRiSTY-BOx <br /> 006FLET10 N COMPL=EMCN <br /> Choc na Surface <br /> SPECIAL PERMIT INFO., <br /> �ta�t <br /> Distance to sewer line It- <br /> Domestic well on site - (y/ n)3 t <br /> If yes, location and distance - ft. <br /> �� . <br /> y' = <br /> epzl <br /> f. d <br /> Sf\lY 1T IJNG - N • •6' slorod Jr <br /> l <br /> Pack <br /> Holding Tepperature 9-4`� <br /> r <br /> Method _ <br /> Screening Method " _ <br /> Tracking Sheet - {y/ n) `r <br /> SPOILS <br /> MATERI ALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted- {Y/ n} Casing type <br /> Storage Location Blank fr. Screen �• <br /> Slot size_ <br /> �NG Bags cement <br /> GR <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Depth to tvater Filter Pack type/size <br /> Mix Ratios Surge Block: - (y/n } <br /> Installation Method Discussed with geologist: - } / n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />