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MONITORING WELL INSTALLATION REPORT <br /> Date: y'SI� CONSTRUCTION <br /> Premise Address: Total Depth IZS <br /> MW_ Screen Length (from) l (to) t2S <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) j v 9 (to)— <br /> {' -7 <br /> Inspector: Grout (from) C7 (to) 1°T <br /> Drilling nig type <br /> Permit No. I• Augq,O.D4 't I.D. <br /> Cori}pletio - <br /> Drilling Company: ove pipe/christie box (circle one) <br /> , � M <br /> p. <br /> Driller: e` casing <br /> . . - eight <br /> Consultant' I <br /> Geologist <br /> ABO SFi- <br /> OOMPLETICN CHR�STY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. ct' `Gemnd Surface <br /> Distance to sewer line a grout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - -* n• <br /> ft. ft. <br /> = m <br /> = m <br /> SAMPLING <br /> 0 <br /> slotted — <br /> sac5on — <br /> Holding Temperature _ P <br /> ack <br /> Method — <br /> Screening Method :r _ <br /> Tracking Sheet - (y/n ) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type_ Vc�,• `� <br /> Blank I f ft. Screen 0 ft. <br /> Slot size 02.0 <br /> GROUTING Bags cement <br /> Buckets bentonite_ 10 <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 />