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MONITORING WELL INSTALLATION REPORT <br /> Date: 711� 6,U CONSTRUCTION <br /> Premise Address: p— 6i/ Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cliristie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> he; <br /> Consultant 'v <br /> —EW <br /> Geologist <br /> ABCVE-GACUND <br /> C <br /> COI�LETION NAtS'TY-80X <br /> COMPLEnCN <br /> SPECIAL PERMIT INFO. (around Surfacs <br /> prccrt <br /> Distance to sewer line 1 <br /> Domestic well on site - ( y/ n ) T ft. <br /> If yes, location and distance - �. <br /> it. <br /> SAMPLINGo <br /> •lorod 2 <br /> secicn <br /> Holding Temperature = Ravi F <br /> ack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <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 />