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MONITORING WELL INSTALLATION REPORT <br /> Date: b/��'l d� CONSTRUCTION <br /> Premise Address:— Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> 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 /> IF heicht <br /> Consultant Qn o'_W i S <br /> Geologist •- <br /> JWVE-GROUND <br /> COWLE7{ON COtiPLETICN Ct-MPLE CN <br /> SPECIAL PERMIT INFO. Ground Suiacs <br /> Distance to sewer line pf0tn <br /> Domestic well on site - (yni) _ft <br /> If yes, location and distanc - <br /> ff. <br /> ft. <br /> - o <br /> O <br /> SAMPLING slotted <br /> e iac�cn <br /> HoldingTem erature <br /> >: SxzN4 pack <br /> Method 4_4" r1 2- H- — <br /> Screening Method zt 400 .*. <br /> Tracking Sheet - 0/ n ) <br /> SPOILS <br /> Storage Method AIATERIALS/DEVELOPMENT <br /> Contamination Noted -�7/ n ) <br /> Storage Location Casing type 7 ak'e - <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water- Bags sand/gravel <br /> Mix Ratios 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 />