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MONITORING WELL INSTALLATION REPOT <br /> Date:,. 3 tbi __. CONSTRUCTION <br /> Premise Address: Y2'� �� + 'st Total Depth I r , 6 <br /> Screen Length (from) (to) <br /> Well No.: 8–1 , E-_Z, ? Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. _ � Grout (from) (to) <br /> Drilling rig type <br /> Permit No. o0 Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/clu�istie box (circle one) <br /> X�. <br /> Driller: casing <br /> height <br /> Consultant <br /> , <br /> Geologist <br /> ABOVE-GRCIJND <br /> COMPLETION CNAIM-BOX <br /> SPECIAL PERMIT INFO. (fib Sumacs COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) _T ft. <br /> If yes, location and distance - ft. <br /> wi 'W <br /> SAMPLING <br /> •torsi — c <br /> sscicn <br /> Holding Temperature off <br /> , - �YW PackMethod =u' <br /> Screening Method kv <br /> Tracking Sheet - (y/ n4. <br /> — <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> 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 />