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MONITORING WELL INSTALLATION REPORT <br /> • <br /> Date: CONSTRUCTION <br /> Premise Address.a 2 '7 f" Total Depth <br /> Screen Length (from) (to) <br /> t7LN �l- 3P P���6PWell No:: <br /> Filter Pack (from)—(to)— <br /> Bentonite <br /> from) (to)Bentonite (from) (to) <br /> Inspector: 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 �n.e .tS -�. /w�co•^3 <br /> Geologist Aoklw�d -_ <br /> ABO -GROUNDCHR*TY4= <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Gmund sulace <br /> Distance to sewer line gf°"I <br /> Domestic well on site - (y/n ) 1 n <br /> If yes, location and distance - <br /> O <br /> P <br /> O <br /> C <br /> O <br /> SAMPLING sbttetJ _ B <br /> 7p sao9on ±>'s <br /> Holding Temperature <br /> Method Vd AS ' _— <br /> Screening Method &i (✓ <br /> Tracking Sheet - ( /rl _— <br /> njr L Z = tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) be/ <br /> Storage Location Casing typeL <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water �t- L 6 S 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 />