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MONUORING WELL INSTAI.LATI ON REP ORT <br /> Date: CONSTRUCnON <br /> Premise Address: , �J Total Depth <br /> Screen Length (from) (to) <br /> Well No.: r' �r Filter Pack (from) (to)- <br /> �/ Bentonite (from} (to) <br /> Inspector: fa �Nti GrouC (from) I <br /> -(to) <br /> - <br /> -Drilling rig type <br /> Permit No. Auger O.D. I.U. <br /> Completion - Stove pipe/christle box (circle one) <br /> Drilling Company: <br /> Driller: Casing. <br /> • <br /> rt <br /> - � e;gilt <br /> Consultant .[ tll. IFmWT <br /> Geologist -- <br /> ABO VE-G R CUN D Gt :STY 2oX <br /> COWL_EMN CO&?l.c' nCN <br /> SPECIAL PERMIT INFO. Cirwnd Suiact <br /> Distance (p� elver line pta <br /> Domestic Drell on site - (y/ n) <br /> If yes, location and distance - <br /> c <br /> a <br /> SAMPUNG stor�i [ <br /> tocicrl -, <br /> Holding Tem erature `t V %r <br /> Method�DgI - '' <br /> ^ ' <br /> Screening Method <br /> Tracking Sheet y n ) {' <br /> K. w14 rtt. <br /> SPOILS <br /> Storage Method MATERIALS EVELOPMEW <br /> Conti�minatzon Noted - (y/n ) <br /> Storage Location Casing type <br /> BIank fc. Screen fc• <br /> SIot size <br /> GROU'T'ING Bags cement <br /> rr Buckets bentonite <br /> Depth to water_ J i3�_�__ 132gs sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> --1pstallation Method Surge Block: - ( y/ n ) <br /> Quantity installed Discussed with geologist: - (y/ n } <br /> Type of method <br /> EH 29 29. . <br />