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MONITORING WELL INSTALLATION REPT <br /> Date: �-Co ds CONSTRUCTION <br /> Premise Address: Total Depth Z.d Z LS <br /> / Screen Length (from) (to) <br /> Well No.: l`�.tv hi7 — (> 4— Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: f Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:?4,_ <br /> Driller: casing <br /> " � � height <br /> Consultant l L11� T <br /> Geologist '" <br /> ASOVE-GROUND Ct�iSSTY-80X <br /> COMPLETCN COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sulacf <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) ft. <br /> If yes, location and distance - <br /> tt. <br /> = m <br /> e <br /> m <br /> 0 <br /> SAMPLING slotted <br /> &4&=on <br /> Holding Temperature 7 = gm„w pack <br /> Method = <br /> Screening Method TU = <br /> TrackingSheetn ) <br /> SPOILS <br /> Storage Method k)f!; MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ ) <br /> Storage Location Casing type /A <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonit <br /> Depth to water C Bags sand/grave <br /> Mix Ratios Filter Packtype size <br /> Installation Method Surge Block: - y/ n ) <br /> Quantity Installed L Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />