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MONITORING WELL INSTALLATION REPORT <br /> Date:.<,> CONSTRUCTION <br /> Premise Address: Total Depth_ $4. 1 p <br /> Screen Length (from) (to) $� I(� <br /> Well No.: M —2� Filter Pack (from) (to) �. p <br /> Bentonite (from) O. S (to) (o. <br /> Inspector: Grout (from)_ O (to)_ �v• S <br /> Drilling rig type <br /> Permit No. Auger O.D. R" I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: casing <br /> height <br /> Consultant_ C-4� � • <br /> Geologist -- aV rYU0YL4 '� CV ►r1 �► <br /> ABOVE-GROUND <br /> COMPLETION CNRZSTY-80X <br /> SPECIAL PERMIT INFO. Ground Solace COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - <br /> 140. ft. <br /> = m <br /> = m <br /> SAMPLING = o <br /> slatted — c <br /> aec�on = <br /> Holding Temperature <br /> Method — gni Pack <br /> Screening Method = <br /> Tracking Sheet - (y/ n4.) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type_ L. o <br /> Blank_ -+a ft. Screen <br /> Slot size 0.020 <br /> GROUTING Bags cement <br /> Buckets bentonite_ <br /> Depth to water Bags sand/gravel �3 <br /> Mix Ratios Filter Pack type/size -R3 <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> EH 29 29 Type of method <br />