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MONITORING WELL INSTALLATION REPORT <br /> )� CONSTRUCTION <br /> ON <br /> Date: /v- / / O Z <br /> j Total Depth (to) <br /> Premise Address: `� Saeen Length Cfrom)-- (to)_ <br /> Well <br /> I�ny Filter Pack (from)—(to) <br /> Well No.: Bentonite (from)— <br /> (to) <br /> Grout (from). <br /> M <br /> Inspector. Drilling rig type <br /> Auger O.D. _ I.D. ___— <br /> Permit No. / Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: I I height <br /> Consultants <br /> GeologistCCv <br /> � A80VE GRCUND rtSTY 30X <br /> COkSPLE710N CCMPL.�T1CN <br /> �.,�Orout�Suiact <br /> SPECIAL PERMIT INFO. start <br /> Distance to sewer line _ ft. <br /> Domestic well on site - (y/ n) ft, <br /> If yes, location and distance - R <br /> V _• 0 <br /> M <br /> C <br /> O <br /> slonnd <br /> SAMPLING 7�y ' axicn —_ <br /> Holding Teyrgper!at�e <br /> Method /`✓cl CCvni z� .r —_ <br /> Screening Method <br /> Tracking Sheet <br /> SPOILS <br /> MATERIALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted - (y/ n) Casing type fr, <br /> Storage Location Blank Screen — <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> 1 Bags sand/gravel <br /> Pack <br /> type/ <br /> Depth to water U r�c� Filter Pack type/size <br /> Mix Ratios Surge Block: - (Y/tl ) <br /> Installation Method Discussed with geologist: - (y/ n ) <br /> Quantity installed Type of method <br /> EH 29 29 <br />