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11ONITORING WELL INSTALLATION REPO• <br /> Date: ��'�� 'O CONSTRUCTION <br /> Premise Address: "r' / C s «"� Total Depth <br /> Screen Length (from) -(to) 3 <br /> Well No.: �'s Filter Pack (from) (to)�— <br /> Bentonite (from) (to)�— <br /> Inspector: AL'Ze� Grout (from)—(to)- <br /> Drilling <br /> from) (to)Drilling rig type � LY01 <br /> Permit No. Auger O.D. 5/g I.D. <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: iLX� <br /> Driller: At41 yaet=-P casing <br /> height <br /> Consultant <br /> Geologist T <br /> ABOVE-GROUND CHRISTI BOX <br /> COMPLETION OMPLEnON <br /> SPECIAL PERMIT INFO. / Grourd SuAan <br /> Distance to sewer line Nlid ^-_J t grout <br /> Domestic well on site - (y/ n) / �` 45 n <br /> If yes, location and distance - n <br /> .fin. <br /> yi P <br /> C <br /> SAMPLING slotted <br /> section — <br /> Holding Temperatures qmvei pack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method /K a� - /mac"'f MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y U Zn P v e— <br /> Storage Location Casing type <br /> Blank S ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite 'L6-4 <br /> Depth to water �d Bags sand/gravel -P�= <br /> Mix Ratios Filter Pack type/size/ <br /> Installation Method At Surge Block: - (y n) <br /> Quantity Installed- Discussed with g st: - (y <br /> Type of method <br /> EH 29 29 <br /> // /b-01 PZ' 5 <br />