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MONITORING WELL INSTALLATION REPOn f <br /> Date: CONSTRUCTION <br /> Premise Address: 1 N• W� Total Depth_ /00 <br /> Screen Length (from) 16d (to) dd <br /> Well No.: Filter Pack (from) (to) Y d' <br /> Bentonite (from) (to)4S <br /> Inspector: Grout (from) P5 (to) 6 <br /> Drilling rig type S <br /> Permit No. Auger O.D. <br /> Completion - Stove pip /christie box Circle one) <br /> Drilling Company: <br /> Driller: r1 casing <br /> height <br /> Consultant A-6 <br /> E � , <br /> Geologist <br /> ABO VE-G R OUN D <br /> CCWPLETCN CMPLETIO <br /> COMPLETION!� ON <br /> SPECIAL PERMIT INFO. 5 Ground Suiacw <br /> 0 <br /> Distance to sewer line } gfOutp <br /> Domestic well on site (y n ) 0 ft <br /> If yes, location and distance - <br /> � 70, ft. <br /> = m <br /> I = m <br /> . a <br /> SAMPLING �lottsd = <br /> Holding Temp rature -- 9 P <br /> Method — <br /> Screening Metho c` <br /> Tracking Sheet - ( y/ n ) <br /> O� ft. <br /> SPOILS <br /> Storage Method v MATERIALS/QEVELOPMENT <br /> Contamination Noted - (y n Q Q I <br /> Storage Location Casing type <br /> Blank Q p ft. Screen ft <br /> Slot size <br /> GROUTING Bags cement <br /> / ^i Buckets bentonite O <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size , <br /> Installation Method/ Surge Block: - (y/ n ) <br /> Quantity Installed z Discussed with geologist: - ( y/ n ) <br /> �l Type of method <br /> EH 29 29 <br />