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MONITORING WELL INSTALLATION REPORT <br /> � c_. w 3 cep <br /> 1 <br /> F(- L.A) �?- <br /> Dace• <br /> CONSTRUCTION <br /> Premise Address: Total Depth L -� <br /> 1 1 S Screen Length (from) <br /> Well No.: <br /> C VlJ I - Filter Pack (from)_ 3_.2) (to) <br /> ]`�? <br /> Bentonite (from) —(to) <br /> Inspector. Grout (from) (to) <br /> Drilling rig type R(>� S, � <br /> Permit No. Auger O.D. I.D. <br /> 1 w Completion - Stove pipe/christie box (circle one) <br /> Trilling Company: <br /> casing <br /> Driller: <br /> height <br /> Consultan7//, <br /> t_ <br /> Geologist. � ' ) F6 <br /> AE p; E-GRCUND <br /> COMP1..�T{ON CNRtS'TY-30X <br /> L3� CCMP <br /> � LET1CN <br /> MI <br /> SPECIAL PERT INFO. Ground Su lwe <br /> j J grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - ��ft ft. <br /> SAMPLING �r �lorai <br /> aQc'icn <br /> Holding Temperature <br /> Method ry = <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) Casing type "?– i r <br /> Storage Location Blan� ft, Screen_-1 y ft- <br /> Slot size <br /> GROUTING r Bags cement <br /> Buckets bentonite <br /> Depth to water 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 />