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MONITORING WELL INSTALLATION REPORT <br /> Date: 1 CONSTRUCTION <br /> Premise Address: Total Depth ' S� <br /> Screen Length (from) (to) "`( <br /> Well No.: Filter Pack (from) (to) `l <br /> Bentonite (from) -(to) � <br /> Inspector. Co- Grout (from) P5 (to) <br /> Drilling rig type <br /> Permit No. Auger O-D. 55 " I.D. <br /> Completion-Stove pipe/christie box (circle one) <br /> Drilling Company: 'TC�'X ��inn�' S <br /> Driller. ��+ti. - �n� CAA. x '4 casgng <br /> height <br /> Consultant <br /> Geolog-ist�—~f �� . <br /> ABCVS-GRCUND CH SY-3CX <br /> CrArP�TrON C.^MP_='T1CN <br /> SPECIAL PER12T INFO. cu-junC Wf=* . <br /> Distance to sewer line <br /> Domestic we-71 on sits (y/ n ) <br /> If yes, locarion distance - <br /> AIL <br /> 72SA YTL.ING <br /> Holding Temperature <br /> Method <br /> Screenin ethod <br /> Tracking Sheet - (y/ n) <br /> tL <br /> SPOILS <br /> Storage Method <br /> �J MATERIALS/DEVELOPMENT <br /> Conratnina ' gored - (y/ n ) <br /> Storage tiocanon Casing type <br /> Blank y-9 fr. Screen 5 <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to ware_- Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 2 Z- <br /> Installation Method a Surge Bloch - Cy/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ nPIt <br /> ) <br /> Type of method <br /> EH 29 29 <br />