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MONITORING WELL INSTALLATION REPORT <br /> Date: "/ l31 1–� CONSTRUCTION <br /> Premise Address: Total Depth (08 , 67S <br /> NO . �� Screen Length (from) `S (to) �Q <br /> Well No.: Filter Pack <br /> (from). Xq' (to) <br /> Inspector: Bentonite (from) SZ (to)�_ <br /> Grout (from) v (to) SS 2— <br /> Drilling <br /> Drilling rig type <br /> Permit No. Auger O.D. P7" I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist7A�fVN <br /> ABOVE-GROUND <br /> COMPLETION CHRLM-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Geound Surlacs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) Jr2ft. <br /> If yes, location and distance - <br /> ft. ft. <br /> = m <br /> = m <br /> SAMPLING = <br /> slotted = B <br /> sa�on <br /> Holding Temperature = <br /> Method gmylw Pack <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> ft• — �� ft. <br /> SPOILS <br /> Storage Method M_ ATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing a <br /> Blank ft. Screen 10 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 />