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MONITORING WELL INSTALLATION REPORT. -#-.+ ; <br /> Date: j y fl 'y '- .. CONS'CItUCTiON i . y <br /> i <br /> D W� Total Depth <br /> Premise Address:_13 Screen Length (From) (to) <br /> -`� , tip. - -- <br /> Filter Pack (from) (to) <br /> Well No.:Z-1 <br /> Bentonite (from) � (to) <br /> / Grout (from) (to) <br /> Inspector �!r""`'P��-.� — Drilling rig type <br /> Auger O.D. I.D. ,..•� ; <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller _ he; <br /> Consultant <br /> Geologist ABOVE-GBCUND CHmM-3OX <br /> A 5 'k 3�- COWLIT" Cp}.PLEE ON <br /> G=nd Sulwt <br /> SPECIAL PERMIT INFO. <br /> E fltcut <br /> Distance to sewer line 1 <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - • . • <br /> f <br /> SAMPLING s4'i = <br /> Holding Temperature �U — q-"v't F <br /> ack <br /> Method <br /> i Screening Me od -f2 <br /> Tracking Sheet - {y/Lfy) <br /> r ft <br /> SPOILS .. <br /> . Storage Method <br /> IIIA MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n) Casing type <br /> Storage Location N�� Blank ft. Screen_______---ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water ��� � � <br /> Mix Ratios Filter Pack type/size <br /> Installation Method -ire <br /> Surge Block: - (y/ n } <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of rncthod <br /> EH 29 29. _ <br />