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MONITORING WELL INSTALLATION REPORT <br /> Date: �� CONSTRUCTION <br /> Total Depth <br /> Premise Addresss: 7 E:—h <br /> Screen Length (from) (to) <br /> .� Filter Pack (from) <br /> Well No.: 12 2. -� <br /> Benronite (from) . ''7 Cto)—� <br /> i <br /> Inspector. � . Grout (from) "'u (to},<'<.*i.«r= <br /> Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion • Stove pipe/duistie box (circle one) <br /> Drilling Company: //��s� ���f1Lr� � <br /> casing <br /> Driller: � height <br /> Consultant /�• T <br /> Geologist �� ! ��✓ AZA t:-G8CUND <br /> 67 CcfvFLE7;CN CCMPLE7ICN <br /> Ground SuAzs <br /> SPECIAL PERMIT INFO. <br /> grout <br /> Distance to sewer line RR 215 <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - n' <br /> �ft. <br /> r <br /> — o <br /> ibnvd � <br /> SAMPLING u aar'on <br /> Holding <br /> ethTempe a tre <br /> Mod <br /> ScreeningMethod <br /> Tracking Sheet / n ) <br /> J� ft — tL <br /> SPOILS <br /> // / <br /> Storage Method /7�1 n!`,f MATERIALS/DEVELOPMENT J a <br /> Contamination Noted Casing type <br /> Storage Location_clb l"�f>f� - Blank �Zy fr, Screen z3 h• <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gravel #L <br /> Depth to water Filter Pack type/size <br /> Mix Rados Surge Block: - ( y/ n ) <br /> Installation Method Discussed with geologist: - (y/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />