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MONITORING WELL INSTALLATION REPOkT <br /> Date: Cg-i - `i fl <br /> CONSTRUCTION <br /> ' <br /> Premise Address: 3`i 3 7 ""i' Total DepthScreen Length (from) (to) <br /> Well No.: 1R- Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: C . v z Grout (from) (to) <br /> Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. O 5���-- Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: G r e <br /> casing <br /> Driller AI-,`s P�e^^� ,F height <br /> Consultant _1_/?__.1�1 <br /> Geologist ��s f AjCvE-GACUND CHRZTY•aox T <br /> CCiFLEMN COWL EMN <br /> Cacvund Surface <br /> SPECIAL PERMIT INFO. <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - ft' <br /> _ <br /> a <br /> P l " z� slct ad = c <br /> SAMPLING secson <br /> Holding Temperature "' _ '�"`al Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> ft _ }t. <br /> SPOILS <br /> Storage Method <br /> 6 MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y Casing type toC <br /> Storage Location sAAG-u° �� z' Blank—.ft- <br /> Slot <br /> lank ft, Screen h• <br /> Slot size . a <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> C) ' Bags sand/gravel s <br /> Depth to water Filter Pack type/size <br /> Mix Ratios `?� /fie�z Y� ° ; �'"°'f <br /> od �rP�m� e ���� � _ Surge Block: - �/ n <br /> Installation Meth ) <br /> Quantity Installed Discussed with geologist: - (� n ) <br /> Type of method "o e- <br /> EH 29 29 <br /> Si 0 �/a� � vs- � <br />