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• <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: 7/ 47�3 ( �a'tt�2//l(ecI CON�I'RUCTION <br /> e S4�4 Total Depth <br /> Premise Address: <br /> Screen Length (from) (to) <br /> Well No.: Filte- Pack (from) (to) <br /> Bentonite (from) (to) <br /> Grout (from) (to) <br /> Inspector: Drilling rig type <br /> Auger O.D. 10"' I.D. <br /> Permit No. Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller:' height <br /> Consultant <br /> Geologist ABcVE-GacuNo C�GZTY-Sox <br /> COMPLETION COMPLETION <br /> Grwrd S slats <br /> SPECIAL PERMIT INFO. <br /> prod <br /> Distance to sewer line _ft. <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - tt <br /> Y' <br /> C <br /> O <br /> SAMPLING slonnd <br /> socicn —_ <br /> Holding Temperature = __ <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y <br /> tt. — <br /> SPOILS <br /> MATERIALS/DEVELOPMENT <br /> Storage Method ' cc0 <br /> Contamination Noted - (y/ n) Casing type P j S Ste- l <br /> Storage Locadon Blank fr. Screen_— —(' <br /> Slot size O <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - (y/11) <br /> Installation Method Discussed with geologist: - (y/ n ) <br /> Quantity Installed Type of method — <br /> EH 29 29 <br />