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MONITORING WELL INSTALLATION REPORT <br /> vow btsf ,� <br /> Date: O t CONSTRUCTION <br /> Premise Address: Total Depth <br /> WJZ � Screen Length (from) (to) <br /> Well No.: N M �� `Y Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> r Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant_ <br /> � T <br /> Geologist <br /> ABOVE-GROUND <br /> OOMPLETON Ct-(AfM-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfacs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) ft <br /> If yes, location and distance - <br /> .3 ft. ft. <br /> m <br /> SAMPLING = C <br /> 0 <br /> �btted � <br /> &#c9on — <br /> Holding Temperature <br /> Method —' g'vw Pack <br /> Screening Method = <br /> Tracking Sheet - (y/ n) — <br /> �ft. `= = IFft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted <br /> a <br /> Stora Location I n Casinge L SGS�D <br /> Storage Blank ft. Screen ft. <br /> Slot size Aen <br /> GROUTING Bags cement <br /> i Buckets bentonite <br /> Depth to water _ Bags sand/gravel <br /> Mix Ratios A- Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />