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MONITORING WELL INSTALLATION REPORT <br /> M. CONSTRUCTION <br /> Date: f. .., .,,..,.�. <br /> /244- Total Depth <br /> Premise Address:— Screen Length (from) CEO)— <br /> Filter Pack (from) (to) <br /> Well No.: U' l Bentonite (from) (to)R• _ <br /> Grout (from) (to) <br /> Inspector: Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: 7F height <br /> Consultant <br /> - r T <br /> Geologist ABOY -GBC;tJNfly�pX <br /> COWLET N C1C&t0 ='nC + <br /> ��surae. <br /> SPECIAL PERMIT INFO. <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n) <br /> If yes, location and distance - ft. <br /> ft. <br /> jw N <br /> Q <br /> SAMPLING <br /> Holding TemperatureOCl/ <br /> Method Loa <br /> Screening Method 6 <br /> Tracking Shcet - y n) <br /> ti. t2. <br /> SPOILS <br /> Storage Method �� �S MATERIALS EVELOPMEN'T <br /> Contamination Noted - y/ n_F Casing type <br /> Storage Location ------ 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 />