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MONITORING WELL INSTALLATION REPORT <br /> Date:_ 113,10 CONSTRUCTION <br /> Premise Address:_ Total Depth S� <br /> Screen Length (from)_ \f- 3 (to)�_ <br /> Well No.: Filter Pack (from) <br /> Bentonite (from) <br /> Inspector: LA t l('r^ Grout (from) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: <br /> casing <br /> height <br /> Consultant F T � C_ <br /> Geologist yy\BILA ( )nAct c Tyme_ , <br /> ABOVE-GROUND <br /> COMPLETION C4-iRZT'Y-SOX <br /> SPECIAL PERMIT INFO. / GroundSurface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ 1 , , _ ft. <br /> If yes, location and dis ce - 11JJ - -�-L�— <br /> = m <br /> C <br /> SAMPLING — <br /> slotted B <br /> tecton = <br /> Holding Temperature %�to Ic1t <br /> Pack <br /> Method 6 " h�o,, Le,_ ,,� _ gm"el <br /> Screening Method <br /> Tracking Sheet - ( y/n) _ <br /> SPOILS <br /> Storage Method_ T! 9X-f AA MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size_ . 010 <br /> GROUTING Bags cement <br /> Buckets bentonite t 'ire Y <br /> Depth to water Z 2 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size Z J Z <br /> Installation Method Surge Block: - 0/ n ) <br /> Quantity Installed U Discussed with geologist: - (y n ) <br /> Type of method_ sexy�v cn <br /> EH 29 29 <br />