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MONITORING WELL INSTALLATION REPT <br /> LJ <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth / <br /> Screen Length (from) (to) <br /> Well No.: Fitter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) <br /> (to) <br /> Drilling rig type <br /> Permit Na. Auger O.D. I.D. <br /> Drilling Company: JLp u Completion - Stove pi e/christie box (circle one) <br /> Driller: casing <br /> S ✓ � height <br /> Consultant � C ✓t.- 1�-��-- <br /> Geologist � '^J _ <br /> ASO ROUND <br /> CO LETION <br /> CHR -BOX <br /> 4 SPECIAL PERMIT INFO. Surf LEMON <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n} • <br /> If yes, location and distance - <br /> �• o <br /> 0 <br /> SAMPLING Mal—� slotaQd ^•r c <br /> Holding Temperature <br /> Method _ �"�4�pack <br /> Screening Method <br /> Tracking Sheet - {y/n } <br /> ft. <br /> tt. <br /> SPOILS <br /> Storage Method MA_TERiALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) A <br /> Storage Location Casing type G_ztie <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to waterh/iSb Bags sand/gravel <br /> Mix Ratios Filter Pack typesize <br /> Installation Method Surge Block: - {y/ ) <br /> Quantity Installed Discussed with ge ogist: - ( y/ nEH 29 29 } <br /> jJ^. ' n Type of method <br />