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ABOVE-GROUND <br />ZTY-CO X • <br />CO Fef' LETK) N <br />COMPL:---TICN <br />Grof.Jrx:1Sixfacit <br />ft <br />casing <br />he Lght 11 <br />MONITORING WELL INSTALLATION REPORT <br />Date: 7/01/45 <br />Premise Address: 30902- (1":" Total Depth <br />Screen Length (from) (to) <br />Well No.: <br />Filter Pack (from) (to) <br />Bentonite (from) (to) <br />Inspector: a a„,..i. Grout (from) (to) <br />Drilling rig type <br />Permit No. <br />Auger O.D. I.D. <br />Completion - Stove pipe/christie box (circle one) <br />CONSTRUCTION <br />SPECIAL PERMIT INFO. <br />Distance to sewer line <br />Domestic well on site - ( y / n) <br />If yes, location and distance - <br />SAMPLING <br />Holding Temperature <br />Method <br />Screening Method <br />Tracking Sheet - ( y / n ) <br />SPOILS <br />Storage Method <br />Contamination Noted - ( y / n) <br />Storage Location <br />GROUTING <br />Depth to water <br />Mix Ratios <br />'..Installation Method <br />Quantity Installed <br />EH 29 29 <br />MATERIALS/DEVELOPMENT <br />Casing type <br />Blank ft. Screen <br />Slot size <br />Bags cement <br />Buckets bentonite <br />Bags sand/gravel <br />Filter Pack type/size <br />Surge Block: - ( y / ) <br />Discussed with geologist: - ( y / n) <br />Type of method <br />Drilling Company: <br />Driller: ' <br />Consultant <br />Geologist