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M MONITORING WELL INSTALLATION REPORT <br /> Date:^ 12CONSTRUCTION <br /> Premise Address : d 4 Total Depth <br /> Screen Length (from) (to) <br /> Well No.: `� � J Filter Pack (from) (to) <br /> 0 Bentonite (from) (to) <br /> Inspect or. Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: � casing <br /> height <br /> Consultant <br /> Geologt�•st ABOVE GRCUND <br /> COMPLETION CtffiSTY30X <br /> C MPL°TICN <br /> SPECIAL PERMIT INFO. S�rlxs +�� <br /> grout <br /> Distance to sewer line 1 <br /> Domestic well on site - ( y / n ) <br /> If yes, location and distance <br /> tt. <br /> _ = m <br /> SAMPLING slonad <br /> sac men _ $ <br /> Holding Temperature PsY9I F <br /> Method <br /> Screening Method <br /> Tracking Sheet - ( y / n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) <br /> Casing Storage Location Blanklank type _ft. <br /> Bfc Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water f-7 � �SC 26 S Bags sand/gravel <br /> Mix Rados 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 2929 <br />