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i <br /> MONITORING WELL INSTALLATION REPORT <br /> 2�4 <br /> CONSTRUCI`f ON <br /> Date: l <br /> Address: r U �y l✓ Total Depth <br /> Premise Screen Length (from) (to) <br /> Well No.: T ' Filter Pack ' (from)_ - �(to) " <br /> Bentonite (from) (to) <br /> Inspector. , '�"°�" Grout (from)_ (to) <br /> Drilling rig type <br /> } .E <br /> Permit Auger O.D. I.D. <br /> No. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: height <br /> Consultant �� - 1 <br /> ABOVE-GRCOND <br /> CONFLET>aN COMPLE70N <br /> Getu - <br /> SPECIAL PERT INFO. _ �SxY <br /> MI <br /> '� <br /> •'' "y Aran <br /> Distance tb sewer line <br /> Domestic well on site - (y/ n <br /> If yes, location and distance - ft. <br /> SAMPLING` — <br /> iac�cn <br /> r �f1Y9� <br /> Holding Temperature w <br /> Method "rY <br /> Screening Method - <br /> Tracking Sheet (y/ n) <br /> {� tt. <br /> SPOILS <br /> Storage Method <br /> i MATERIALS EVELOPMENT <br /> Contamination Noted- (y/n ? Casing type <br /> Storage Location Blank : ft, Screen % ft. <br /> Slot size <br /> GRr OUTING • Bags cement <br /> Buckets beri6nite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> installation Method Sutge-Block -,(y/ n] <br /> Quantity Installed Discussed with°geologist: - (y% n) <br /> Type o 11 f rnetliod <br /> EH 291-29 , y <br /> . f <br />