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MONITORING WELL INSTALLATION RFPORT <br /> fCONS ON <br /> Date: ��C 4 b-L' 3� <br /> S/ Total Depth (to) <br /> Premise Address: 1 Screen Length (from) $ (to) <br /> l <br /> Filter Pack (from)—(to)� <br /> Well No.: Bentonite (from)_--- <br /> I, Grout (from) `f (to) <br /> Inspector. l4 nv° ~ Drilling rig tYPe <br /> Auger O.D._� I.D. <br /> Permit No. / Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> 1+ i- <br /> casng <br /> Driller: height <br /> r - <br /> Consultant <br /> Geologist L- � —� ABOVE-GACUND C4-GLM-BOX <br /> OOI gLc-7fCN CCmpt,R CN <br /> G=rd Suiact <br /> SPECIAL PERMIT INFO. grout <br /> Distance to sewer line It. <br /> Domestic well on site - (y/ n) 8 f9 ft. <br /> If yes, location and distance - tt _ <br /> C <br /> O <br /> tlonad c <br /> SAMPLING socicn <br /> .— 73v91 yadc <br /> Holding Temperature <br /> Method — <br /> Screening Method <br /> Tracking Sheet - (y/ tt) ft. _ ft• <br /> SPOILS <br /> eTFFJ t S/DEVELOPMENT <br /> Storage Method �I <br /> Contamination Noted - (y/ n) Casing type ft, <br /> Storage Location Blank }�2_fr- Screen__ <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> /�, Bags sand/gravel <br /> Depth to water c� Filter Pack type/size <br /> Mix Ratios /h/ ° Surge Block: - (y/ 11 ) <br /> Installation Method Discussed with geologist: - (y/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />