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MONITORING WELL INSTALLATION REP. eT <br /> Date: CONSTRUCTION / <br /> Premise Address: /Cl /f�4� i Total Depth 46 <br /> Screen Length (from) (to) <br /> Well No.: T- O/p Filter Pack (from) (to) <br /> Bentonite (from)—� Cto) <br /> inspector. A/L/� Grour (from) Cl (to) L-o <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> �^ l Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller. cats iag <br /> F17V7 <br /> height <br /> Consultant_y <br /> — T <br /> Geologist _ ( I 9 de — <br /> A8C)VE-GRCUNO C7�i15^ 30X <br /> C:..'bP��-CfON CCMPLc?iCN <br /> SPECIAL PERMIT INFO. GfOf nd Sulac* <br /> i <br /> Qt«rt <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) �_g <br /> If yes, location and distance - _ <br /> - a <br /> O <br /> SAMPLING dotted a = a <br /> wc= = <br /> Holding Temperature <br /> Method ` <br /> Screening Method _ <br /> Tracking Sheet - ( y/ n ) <br /> fL = Y tt <br /> SPOILS ��I <br /> Storage Method MATERIALS/DEVELOPMENC <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft screenft. <br /> Slor size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravei <br /> Mix Ratios Fater Pack typesize <br /> Installation Method Surge Block: - C y/ n ) <br /> Quantity Installed Discussed with geologist: - (y <br /> Type of merhod <br /> EH 29 29 <br />