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MONITORING WELL INSTALLATION REPORT <br /> Date: /A7- 'Z��(�9 CONSTRUCTION Gt <br /> Premise Address: <br /> �� l Total Depth X028 l?/ <br /> Screen Length (from) (to) <br /> Well No.: -C9 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:Driller: casing <br /> casing <br /> AA � height <br /> Consultant ft'�Go✓�' <br /> Geologist AE&E-GROUND <br /> COMPLETION CNRISTY-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> proof <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) �_ft. <br /> If yes, location and distance - ft <br /> ft. <br /> = m <br /> _ o <br /> SAMPLING dotted = <br /> socaon — � <br /> Holding Temperature <br /> ack <br /> Method — r <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 cemenj <br /> Buckets bee <br /> Depth to water Bags sand/ <br /> Mix Ratios Filter Pa 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 />