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MONITORING WELL INSTALLATION REPT <br /> CONS ON <br /> Date: .}- � <br /> -)t- Total TotalDept hd`-' (to)_ <br /> Premise Address: —W Screen Length Cfrotn) ° (to) l <br /> Filter Pack (from) <br /> well No.: Bentonite (from)/ _—(CO) <br /> Grout (from 1' (to)5 <br /> Inspector. Drilling rig <br /> Auger C.D.[ / — I.D. /I <br /> Permit No. Completion - Stove pipe/rhristie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: height <br /> Consultant �R ` CST \ Ir <br /> Geologist A' -GRAND CrRtST(30X <br /> coWLETfCN C04tPL TICN <br /> -- GrwndSuix+ � <br /> SPECIAL PERMIT INFO. <br /> Distance to sewer line tvl� prat <br /> Domestic well on site - (y/ n) ft <br /> If yes, location and distance - -tt — <br /> - = o <br /> = c <br /> — o <br /> SAMPLING slornd <br /> socicn —_ <br /> ppB(✓ traval F-� <br /> Holding Temperature <br /> Method <br /> Screenin;Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> MATERIALS EVELOPMENT <br /> Storage Method <br /> Contamination Noted - (y/n) Casing type I7 f� 7rti 40 <br /> Storage Location Blank--j,—ft- Scree <br /> Slot — <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water <- Filter Pack type/size ly <br /> Mix Ratios Surge Block: - (y/ n ) <br /> ,installation Method Discussed with geologist. - 0/ n ) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />