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h,.'.�ITORING WELL INSTALLATION REPORT <br /> Dace:_ 1� _ CONSTRUC 7ON <br /> Premise Address: Total Depth_ <br /> Q Screen Length (tram) <br /> Well No.: Filter Pack (from) (to) <br /> Benconite (from) L/ _(Co) 3 <br /> Inspector. Grout (fro ) (to) <br /> Drilling fig type <br /> Permit No. Auger O.D. I <br /> Completion - Stove pippAtreisrie oz (circle one) <br /> Drilling Company: <br /> __�[ <br /> Driller. Z casing <br /> he=ght <br /> Consultant A,t b4 <br /> Geologist - ABCVE�RCUNO <br /> cc&pt.i rC.'N CC#APL_=MCN <br /> SPECIAL PERMIT INFO. Ground Siafacs <br /> grout <br /> Distance to server line <br /> Domestic well on site - y a ) It- <br /> If yes, location and dis e - A�- <br /> " a <br /> SAMPLING I :torad = c <br /> sac,on - <br /> Holding Temperature p <br /> Method ' _ <br /> Screening Method $ 1S) <br /> Tracking Sheet - (y/ n ) : <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted- (y/ 0 fV C— <br /> Storage Location Casing type <br /> Blank � fr- <br /> ft: Screen <br /> Sloc size f D y <br /> GROUTING Bags cement <br /> Buckets bencorite <br /> Depth to water 'C7 Bags sand/gravel <br /> Mix Ratios Filter Pack typesize <br /> Installation Method Surge Block: - ( y/ a ) <br /> Quancicy Installed Discussed with geologist. - ( y/ n ) <br /> Type of method <br /> E:i 29 29 <br />