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MONITORING WELL INSTALLATION REPORT <br /> Date: �i J a ,a I `� CONS &TION b l A4"-Jle'` <br /> Premise Address:_� w`'`�� �`�' 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 /> Drilling Compan ��� Completion - Stove pipe/christie box (circle one) <br /> y: <br /> Driller: casing <br /> SIL height <br /> Consultant5A it <br /> Geologist 37 <br /> ABOVE-GROUND <br /> COMPLETION CHRJS7Y4= <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Su fact <br /> Distance to sewer line Grp <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - <br /> ft. <br /> ft. <br /> = m <br /> — m <br /> SAMPLING = ° <br /> �lottQd E <br /> Holding Temperature _ P <br /> Method — <br /> ack <br /> Screening Method <br /> Tracking Sheet - (y/ n ) r' _ <br /> ft. <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 /KtA-, ' 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 />