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0 <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Depth <br /> th <br /> Premise Address: P <br /> OS . !� Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector•. ' " ^�'l . 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: LAS E`�2 <br /> Driller: �b casing <br /> / height <br /> Consultant qq��- �V " <br /> 7. <br /> Geologist l <br /> ABOVE-GACUND CHAt5T1'30X <br /> COMPLETCN COMPLETION <br /> SPECIAL PERMIT INFO. .. end Sul'c <br /> Distance to server line arca <br /> Domestic well on site - (y/ n ) tt. <br /> if yes, location and distance - f<, <br /> • � w <br /> C <br /> O <br /> SAMPLING donAi <br /> soden <br /> Holding Temperature = tr,vd Pack <br /> Method <br /> Screening Method _ <br /> Tracking Sheet - (y/ n ) <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) �� " _ <br /> Storage Location Casing type ft <br /> Blank L fc. Screen t' <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water <�U / 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 />