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t ITORING WELL INSTALLATION REPOR <br /> 7— CONSTRUCTION <br /> Date: �� <br /> Premise Address: T�Z� `"� Total Depth 7�v <br /> Screen Length (from), (to) 40 <br /> Well No.: IG!/ 2 Filter Pack (from) (to) (} <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) 3tt (to) E�- <br /> Drilling rig type <br /> Permit No. Auger O.D. 7K I.D. <br /> Consultant <br /> g`S,/B Completion - Stove pipe/christie box (circle one) <br /> ����" <br /> Geologist llz: o � PL-4� <br /> 71, <br /> —QV <br /> SPECIAL PERMIT INFO. /ABOVE-GROUND <br /> rC� COMPLETION CNAfSTY-80X <br /> Distance to sewer line c7 COMPLEEMCN <br /> Domestic well on site - ( y n �Surface <br /> If yes, location and distance - grout <br /> X ft. <br /> SAMPLING >� <br /> Holding Temperature slotted : <br /> Method <br /> Screening Method // _ PXR <br /> Tracking Sheet y n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Notes - / n ) <br /> Storage Location [grl Casing type <br /> Blank 5 ft. Screen ft. <br /> Slot size Q. Q <br /> Bags cement <br /> GROUTING / Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Q � Filter Pack type/size 2 / <br /> Mix Ratios , N"'0 Surge Block: - ( y n <br /> � 1 <br /> Installation Method Discussed with geo ogist: - n ) <br /> Quantity Installed Type of method <br />