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MONITORING WELL INSTALLATION REPORT <br /> CONSTRUCTION <br /> Date: <br /> Total Depth (to) <br /> Premise Address: Screen Length (from) <br /> Filter Pack (from) (to) <br /> Well No.: Bentonite (from) (to) <br /> Grout (from) (to) <br /> Inspector. Drilling rig type <br /> Auger O.D. LD. <br /> Permit No. Completion - Stove pipe/ell tie box (circle one) <br /> Drilling Company: <br /> �— casino <br /> Driller: height <br /> Consultan[ �* <br /> Geologist ApOV–r-GRCUND C'A M3ox <br /> Ca,vpt_ETSON Gpl t?t=�1CN <br /> Cx=rd Stztact <br /> SPECIAL PERMIT INFO. 9=1 <br /> Distance to sewer line �ft. <br /> Domestic well on site - (y/ n) tt, <br /> If yes, location and distance . ft <br /> �— ;: — <br /> I h = <br /> 0 <br /> 0 <br /> SAMPUNG = '� <br /> secicn <br /> '� LraYd Fant <br /> Holding Temperature <br /> Method <br /> Screening Method ' <br /> Tracking Sheet - (Y/ n) tt = ft. <br /> SPOILS <br /> MATE RI ALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted - (Y/ n) Casing type <br /> Storage Location Blank ft. Screen_--�� <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gmvcl <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - (Y/11) <br /> 4pstalladon Method Discussed vrith geologist: - (Y/ n) <br /> Quantity installed Type of nctllod <br /> EH 29 29 <br />