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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address:_ ivy Total Depth��..... <br /> 13 'z �o Screen Length (from) (to) <br /> Well No.: X <br /> 4 7&a-l0 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: 5� <br /> Driller: <br /> casing <br /> height <br /> Consultant `�a--� � <br /> Geologist / - r <br /> Ai80 -GROUND <br /> COMPLETION CNRZTY-BOX <br /> SPECIAL PERMIT INFO. Ground Surfac9 COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - n• <br /> ft. ft. <br /> = m <br /> — m <br /> - C <br /> SAMPLING — s <br /> dotted = c <br /> section . — S <br /> Holding Temperature Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/n ) — <br /> ft. <br /> SPOILS ) <br /> Storage Method 14—f 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 benton' e <br /> Depth to water Bags sand/gravO <br /> Mix Ratios Filter Pack a/size <br /> Installation Method Surge Block - (y/ n ) <br /> Quantity Installed Discussed th geologist: - ( y/ n ) <br /> EH 29 29 Type of method <br />