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MONITORING WELL INSTALLATION REPORT <br /> Date:_ b p _ CONSTRUCTION <br /> Premise Address: FTotal Depth 30, <br /> L/ Screen Length (from) (to)� � <br /> Well No.:__ i1 ��L _ Filter luck (from) (to)—_�o ! <br /> Inspector. Bentonire (from) (� (to)–TI <br /> Grout (from)- -rJ` (to) <br /> �� <br /> Permit No. Drilling rig type Auger D.D. I.D. <br /> Drilling Company: Completion - Stove pipe/c a-istle box (circle one) <br /> Driller: <br /> c a s i ng <br /> Consultant q height <br /> Geologist L(J4 L< _ <br /> ABOVE-GRCUND <br /> cOMPt.ETCN C1HR TY_60X <br /> SPECIAL PEPMIT INFO. t_mcrr <br /> Ground S+aiact <br /> Distance to sewer line Qralt <br /> Domestic well on site - (y <br /> If yes, location and dis ce - It. <br /> w <br /> SAMPLING, c <br /> ilocpi _ c <br /> Holding Temperature :r <br /> Method gm,i9rPack <br /> Screening Method &01M; <br /> Tracking SheetUYn ) <br /> i� <br /> ED <br /> SPOILS <br /> Storage Method C--Y,, MATERIALS/DEVE[.OPMENT <br /> Contamination Noted - <br /> Storage Location <br /> Casing type <br /> Blank___ t7 _fL Screen Q ft. <br /> GRO[1'I'ING Slot size_. . O DC7 �.— <br /> Bags cement <br /> t Buckets bentonite <br /> Depth to water nJ S Bags sand/graveI .,–; <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y 1,4f) <br /> Quantity Installed Discussed with geol ►st: - (y/6D <br /> EH 29 29 <br /> Type of method <br /> T 1 <br />