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MONITORING WELL INSTALLATION REPORT <br /> 1 <br /> `.� p CONSTRUCTION <br /> Date: 6 <br /> ddress:��� Total Depth 5 <br /> !remise A Screen Length (from) (to) <br /> Filter Pack (from) (to) _ <br /> Well No.: rte' Z - Bentonite (from)_ (to) <br /> . Grout (from) (to) <br /> Inspector: h .Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> c sing <br /> Driller: h/e_ght <br /> Consultan <br /> Ge o gi st �' �� 4!fes � Z, ACOVE-GROUND a.SS Y-30X <br /> 1 <br /> COwFLET*N ; C WPt EMON <br /> Ground Sutacs <br /> SPECIAL PERIWIT INFO. <br /> pra.K <br /> Distance to sewer line _-ft. <br /> Domestic well on site - (y/n) #t• <br /> If yes, location and distance - <br /> �A M <br /> SAMPLING �(C,,,A socicn <br /> Holding Temperature <br /> Method <br /> Screenin;IViethod <br /> Tracking Sheet - (y/ n) _ n• <br /> —.ft• <br /> SPOILS c �� <br /> MATERIALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted- (Y <br /> 1 s ) c c Casing type !�� <br /> Storage Location t Blank--.h Screen__ <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gravel <br /> Depth to Nvater- 7 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 />