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MONITORING WELL INSTALLATION REPO <br /> Date: l CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) 143.11 (to) <br /> Well No.: Filter Pack (from) t .46.,Cl (to):ff: <br /> Bentonite (from) (to) 40 <br /> Inspector: Grout (from} (to) i <br /> Drilling rigtype <br /> Permit No. Auger O.D._Q_ I.D. - <br /> Completion-Stove pipe/christie box (circle one) <br /> - Drilling Company: � �/� .,,. --- <br /> Driller ca@Lnq <br /> height <br /> Consultant ♦ - <br /> Geologist V JI ax Ali <br /> ABOVE-GROUND <br /> S <br /> COMPLETION <br /> SPEOAL P COMIX" <br /> Gaurd Sutax �..�. <br /> Distance to sewer line 0rvA <br /> Domestic well on site- (y/a ._.. 0 If yes,location and distance- / fL <br /> r. <br /> n S <br /> v r <br /> Q���p��� is • <br /> siocadr , <br /> Holding Temperature b C/ <br /> Method - — 9'"rs1P` <br /> Screening Method -2 — <br /> Tracking Sheet <br /> :} <br /> SPOILS I> � <br /> Storage Method d b A'[EMALS/DEVELOPMENT <br /> Contamination Noted- n) SE <br /> Storage Location ming type <br /> Blank fr_ Screen Ckft. <br /> Slot size <br /> GROUTING Bags cement <br /> / <br /> Bucketcntonite_ __ <br /> Depth to seater Bags sa gravel <br /> Mix Ratios <br /> Filter-Pack type/size <br /> Installation Method Surge Block: - (Y/CrLy <br /> Quantity Installed . Discussed with geolo i y n} <br /> Type of method <br /> EH 29 29 <br />