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vONITORING WELL INSTALLATION REPO <br /> • s" v <br /> -7 R <br /> Date:_ c� 3 2 CONSTRUCTION <br /> Premise Address: �� " Total Depth I <br /> Screen Length (from) W (to <br /> Well No.: "4J1 f Filter. Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. Grout (fro (to) � <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> ff ,` <br /> Driller: caning <br /> he-;ght <br /> Consultant <br /> —qv, <br /> Geologist•� -- <br /> /lBOVE-GRCUND <br /> GOMPLETCN w�3 cr+�,srir-aox <br /> cvAPL_=ncN <br /> SPECIAL PERMIT INFO. Ground Surfacs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) !t. <br /> If yes, location and distance - <br /> v � m <br /> w <br /> C <br /> SAMPLING siot'a.� <br /> socicn <br /> Holding Temperature .r <br /> "pack <br /> Method <br /> Screening Method = <br /> Tracking Sheet - ( y/ n ) _ <br /> ft. <br /> SPOILS YJj <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n } l�pU�. 'rck Yo <br /> Storage Location Casing a ! l <br /> Blank ft. Screen ft. <br /> Slot size_ C7492O <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water_ Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - 0/ n } <br /> Type of method <br /> EH 29 29 <br />