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0 0 <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: ���� 7 > CONSTRUCTION <br /> Premise Address: h� ( 1/rh �:-f Total Depth e <br /> TU — — Screen Length (from) (to) <br /> Well No.: C F�r Filter Pack (from)—(to)- <br /> Bentonite <br /> from) (to)Bentonite (from) (to) <br /> Inspector. Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller. � casing <br /> height <br /> Consultant-T-c , T <br /> Geologist_ <br /> ABOVE-GACUND CF4i75TY30X <br /> W MPLETbN COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sl7faca <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) <br /> ft. <br /> If yes, location and distance - <br /> ft ft. <br /> — a <br /> - m <br /> = e <br /> = c <br /> SAMPLING dorsi <br /> // sac'cn <br /> HoldingTe{nperature Y°/ pavclpadt <br /> Method ��oq _ <br /> '. <br /> Screening Method <br /> Tracking Sheet - ((j/ n ) _ <br /> tt. IL <br /> SPOILS <br /> Storage Method I4 MATERIALS/DEVELOPMENT <br /> Contamination Noted . ( y <br /> Storage Location Casing type KJA <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water rr 1 j Bags sand/gravel <br /> Mix Ratios n � (_ _ t Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed — Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />