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MONITORING WELL INSTALLATION REPORT <br /> Date: 3.1/6/a-- <br /> CONSTRUCTION <br /> Premise Address: n "1 Total Depth <br /> Screen Length (from) (to) <br /> Well No.:1 Filter Pack (from) (to) <br /> �� IoBentonite (from) (to) <br /> Inspector._ Lk4� Grout (from) (to) <br /> .Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cltristie box (circle one) <br /> Drilling Company: <br /> Driller:_)lse _ casing <br /> (^ IS he_ght <br /> Consultant <br /> Geologist_ uC <br /> ` ABOVE-GRC( D <br /> COMPLETION C_•A:STY-30X <br /> SPECIAL PERMIT INFO. Ground gu{,ct <br /> Distance to sewer line gra <br /> Domestic well on site - (y/ n) It. <br /> If yes, location and distance - <br /> • <br /> v` O <br /> N <br /> f: O <br /> SAMPLING G.G' M <br /> V socicn � <br /> Holding Temperature T <br /> Method <br /> Screenin;Method = <br /> Tracking Sheet - (y/ n ) <br /> S ��.ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) Q <br /> Storage Locadon Casing type <br /> Blank ft. Screen Vfr• <br /> Slot size <br /> GROUPING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Rados Filter Pack type/size <br /> dnstallation Method Surge Block: - (y/n ) <br /> Quantity Installed Discussed with geologist: - (y/ n <br /> Type of metliod <br /> EH 29 29. . <br />