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MONITORING WELL INSTALLATION REPORT <br /> Date: VS� <br /> CONSTRUCTION <br /> Premise Address: (� t 1 Total Depth Y� <br /> LP �� 7 <br /> C� Screen Length (from) T-3,60) <br /> � <br /> Well No.: 1 t Filter Pack (from (to) <br /> Bentonite (from) (to) <br /> Inspector: M Grout (fro (to) <br /> Drilling rig type f— <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie os (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> / height <br /> Consultant (��-0 `V � <br /> 7//, _WVT <br /> Geologist .- <br /> ABOVE-GFiCUND <br /> COMPLETION G-iAtSTY-30X <br /> COAAPLE7CN <br /> SPECIAL PERMIT INFO. Ground Sudws <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - <br /> C ��s <br /> C <br /> M <br /> SAMPLING slot*" ' _= g <br /> xocycn y _ <br /> Holding Temperature = gave F <br /> ack <br /> Method = <br /> Screening Method r = <br /> Tracking Sheet - (y/ n ) <br /> a.. fi. fL <br /> SPOILS Q 'e//p <br /> Storage Method _ 4MATERIALS/DEVELOPMENT <br /> Contamination Note ( Y/ ) i/ <br /> Storage Location 4 f1 Casing typed' <br /> Blank to ft. Screen ft. <br /> Slot size 0.0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water /� Bags sand/gravel <br /> Mix Ratios /,1 Filter Pack type/siz --d" <br /> Installation Method Surge Block: - ( y/ ) <br /> Quantity Installed Discussed with geologist: - (�/ n ) <br /> Type of method <br /> EH 29 29 <br />