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MONITORING WELL INSTALLATION REPORT <br /> f1 CONSTRUCTION <br /> Date: <br /> �/ ., t_ `t. �/►'"��--� �`` Total Depth <br /> Premise Address: Screen Length Mom) (to) <br /> U Filter Pack (from). (to) <br /> Well No.: <br /> Bentonite (from) (to) <br /> Grout (from) (to) <br /> Inspector, -'� - - Drilling rig we <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/cluisde bo (circle one) <br /> Drilling Compan <br /> casing <br /> Driller:' Fr <br /> heicht: ' <br /> q ; <br /> Geologist2�-"( ABOVE-GRCUNfl C�+n:STY-3GX <br /> CO dam'LETiON ,tr L-iZC,y <br /> C�roc:r�d Sufaca ��---.-••� <br /> SPECIAL PERMMT INFO. <br /> pram <br /> Distance to sewer line -,� -_ft. <br /> Domestic well on site - (y/ n} P. <br /> If yes, location and distance - �. <br /> C <br /> O <br /> SAMPLIiVG soc'icn - <br /> -' �ravai;.mac <br /> Holding Temperature <br /> Method <br /> Screening Method -' r <br /> Tracking Sheet - {y/ n ) #?. <br /> SPOILS <br /> MATERIAL EVELOPMENT <br /> Storage Method �-�� <br /> Contamination Noted - {y/n} Casing type <br /> Storage Location Blank ft Screen <br /> Slot size <br /> Bags cement <br /> GROUI"CNG Buckets bentonite <br /> nags sand/gravel <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - (Y/ n ) <br /> ,\Installation Method Discussed with geologist: - (y/ n ) <br /> Quantity Installed Type of nc[hod <br /> EH 29 29 <br />