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- MONITORING WELL,INSTALLATION REPORT <br /> Date: �d CONSIRUC67ON <br /> Premise Address: / P` ^� <br /> Total Depth <br /> . ) Screen Length (from) (to) <br /> Wel! No,: Filter Pack (from) (to)__ <br /> Inspector Bentonite (From) (to)�� <br /> p 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 /> Drulef. g4±u1AD&Q casing. <br /> height <br /> Consultant A�r <br /> Geologist 6'c <br /> APAYE-G rRCVND <br /> OOWLcT)ON G-RM Y-BOX <br /> C0XAPUEETiGN <br /> SPECIAL PERMIT INFO. G=nd Sui3ct ..� .. <br /> Distance to sewer line c—..Ik-- Gr« <br /> Domestic well on site,- (y/n <br /> If yes, location and distance - <br /> v� o <br /> SAMPLING �nasl Tu-�-�-• <br /> -g <br /> Holding Temperature „r <br /> Method <br /> 1;n Pack <br /> Screening Method <br /> Tracking Sheet - (�y%/ n } ' <br /> It. <br /> SPOILS <br /> Storage Method tIIJ• MATE_W_ALS_/DEVELOPMENT <br /> ContMEnation Noted -. <br /> Storage Location 6h-S Casing type <br /> Blank fc. Screen---.ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water' P Bags sand/gravel <br /> Mix Rados Filter Pack type/size <br /> installation Metho Surge Block: - ( y/ ai ) <br /> Quantitylnstalled S Discussed with geologist: - ( y/ n } <br /> Type of netliod <br /> EH 29 29. . <br />