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MONITORING WELL INSTALLATION REPORT <br /> Date: LN-V190 CONSTRUCTION <br /> Premise Address: 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/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> e- height <br /> Consultant <br /> Geologist <br /> I1BCVE-Grg0UND <br /> CONFLETfCN C-SZTY-80X <br /> SPECIAL PERMIT INFO. around Surface COMPLETiCN <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> — m <br /> - C <br /> SAMPLING : <br /> •lor. d — <br /> socicn <br /> Holding Temperature _ Ravi F <br /> ack <br /> Method —_ <br /> Screening Method = <br /> Tracking Sheet - ( y/ n ) c: _ <br /> ft• — M <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/ ii ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />