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MONITORING WELL INSTALLATION REPORT <br /> Date: �l r CONSTRUCTION <br /> Premise Address: �-- Total Depth 9b <br /> Well No.: �j Screen Length (from) ' D (to) <br /> Filter Pack (from) (to)_ <br /> Bentonite (from) (to)–,?-7 <br /> Inspector: Grout (from) 0 (to) _ <br /> Drilling rig type <br /> Permit No. Auger O.D.---A- I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: <br /> � casing <br /> height <br /> Consultant <br /> Geologi ,� T <br /> ABOVE-GROUND <br /> COMPLET;ON CNRLM_BOX <br /> SPECIAL PERMIT INFO. Ground Suriaca COMPLETION <br /> Distance to sewer line Cts <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - . ft. <br /> = m <br /> = m <br /> SAMPLING <br /> slotted — <br /> soc�on <br /> Holding Temperature _ vivo,P <br /> ack <br /> Method — <br /> Screening Method = <br /> Tracking Sheet (y/ n) <br /> �v n, <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type_ Sc;. t4D <br /> Blank t�O ft. Screen <br /> Slot size_ Q. nT-c> — <br /> GROUTING Bags cement <br /> Buckets bentonite 2. S <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 13 <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />