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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: NfcG Total Depth��.�o� � 32! zb S <br /> Screen Length (from) (to) <br /> Well No.: 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 /> " L Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: 7 /SC� <br /> Driller: /Ci casing <br /> height <br /> Consultant �.�� ��' <br /> Geologist aAIRT <br /> ABOVE-GROUND <br /> COMPLETION CHRIS 4I OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfaas <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - <br /> ft. ft. <br /> SAMPLING = ° <br /> slotted : � <br /> aac9on ^• <br /> Holding Temperature <br /> Method _ gnW P <br /> ack <br /> Screening Meg6a <br /> Tracking Sheet y/n ) Sca 4� <br /> SPOILS <br /> Storage Method MATERIALS/DEVE�OPMENT <br /> Contamination Noted - (y/ n ) r''! <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> { Buckets bentonite <br /> Depth to water � `�b Bags sand/gravel <br /> Mix Ratios 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 />