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F- <br /> MONITORING WELL INSTALLATION REPOkr <br /> Date: J/ CONSTRUCTION <br /> Y CONSTRUCTION <br /> Premise Address: f[p'^'� Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> II"" Bentonite (from) (to) <br /> Inspector. k Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O .D. I.D. <br /> Completion - Stove pipe/clu-istie box (circle one) <br /> Drilling Company: � a �CY �� <br /> Driller: F11 <br /> � casing <br /> � he ±ght <br /> Consultant X� � a � i T <br /> IV <br /> Geologist r <br /> ABOVE-GRCUND CtW SfY80X <br /> COWlEiION CVAPL-'TiCN <br /> SPECIAL PERMIT INFO. S�'c' <br /> Distance to sewer line drat <br /> Domestic well on site - ( y / n ) ft. <br /> If yes, location and distance - <br /> ,r <br /> ._ ( l_tt. <br /> c <br /> SAMPLING �larad <br /> sacicn —_ <br /> Holding Temperature 72Va! Pack <br /> Method = <br /> Screening Method = <br /> Tracking Sheet - ( y / n ) <br /> lot <br /> SPOILS TJf � <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) /I <br /> Storage Location Casing type /��f/ - <br /> Blank r�_ft. Screen ( D K# <br /> Slot size0 (2Lo <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 3 <br /> Mix Rados Filter Pack type/size <br /> -installation Method Surge Block: - ( y / n ) <br /> Quantity installed Discussed vAth geologist: - ( y / n ) <br /> Type of method <br /> EH 29 29 - <br />