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14ITORING WELL INSTALLATION REPOR <br /> v <br /> Date: �'�Z CONSTRUCTION <br /> Premise Address: ZS Z S- � "'' {� <br /> Total Depth <br /> Ski ' . <br /> Screen Length (from) (to) <br /> Well No.: Ss ! � , (.'(7 Z f�l�i 1JFilter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Permit No. ° �gd9 Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company: /S <br /> Completion - Stove pipe/christie box (circle one) <br /> � <br /> Driller:- �� � casing, <br /> height <br /> Consultant / A4E;;VF-.CFRt <br /> Geologist p`� VInON <br /> NO <br /> CONFLETION <br /> SPECIAL PERMIT INFO.�� ffGround Surace <br /> Distance to server line 14/ Gr <br /> Domestic well on site - (y/ )p <br /> If yes, location and distance - ft. <br /> --ft. ft. <br /> — - m <br /> SAMPLING _ c <br /> Mot, <br /> Holding Temp•:rature s 'cn = B <br /> Method = Ram Pack <br /> Screening Meclod —' <br /> Tracking Shce° - (y/ n ) <br /> SPOILS ft. w — ft. <br /> Storage Method <br /> Contamination Noted - (Y/nMATERIALS/DEVEI OPMENT <br /> ) <br /> Storage Location typ <br /> Casinge p <br /> Blank ft. Screen ft. <br /> GR_ OUTING Slot size <br /> Bags cement <br /> Depth to wat / ,�/k Buckets bentonite <br /> Mix Ratios Bags sand/gravel <br /> Installation Method Filter Pack type/size <br /> Quantity Instal.ed Surge Block: - (y <br /> Discussed with geologist: - ( y/ n ) <br /> EH 29 29 Type of method <br />