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MONITORING WELL INSTALLA'T'ION REPORT <br /> a CONSTRUCTION <br /> Date: ' �n <br /> bo <br /> Prem <br /> (�" �j �CoT 'Total Depth �- <br /> Premise Address: Screen Len7type <br /> om) (to) <br /> LL .L y Filter Packm) (to) <br /> Well No.: J� Bentoniteom) (to) <br /> Grout om) (to) <br /> Inspector. t-o""'" Drilling rig <br /> Auger O.D. Stovi /chrisI.tPermit No. Completion - ppeDie. <br /> box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: height <br /> Consultant �� �► <br /> Geologist — J- VE-GRC(JNDt.ECfON CO PL_EMN <br /> c=rud su act <br /> SPECIAL PERMIT INFO- flrocrt <br /> Distance to sever line ft. <br /> Domestic well on site - (y <br /> If yes, location and distance - <br /> V' M <br /> > 1P <br /> O <br /> SAMPLING socicn <br /> Holding Temperature <br /> Method � /�-�"'" �•( ,:� _ <br /> Screening Method <br /> Tracking Sheet y n) <br /> SPOILS <br /> N /� MATEWALS/D�i.OPMENT <br /> Storage Method l <br /> Contamination Noted- ffy/ n) Casing type ft. <br /> Storage Location gl ft. Sere <br /> Slot size <br /> Bags cement <br /> G _R_OT-MNG Buckets bentonite <br /> /f Bags sand/gravcl <br /> Depth to�vater� Filter Pack type/size <br /> Mix Ratios Surge Block: - (Y <br /> ipstalladon Method •-�-` Discussed with geologist: - (y/n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />