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MONITORING WELL INSTALLATION REPOni <br /> Date: 70,1r-I I/qTy CONSTRUCTION <br /> Premise Address: 30// ' Y" Total Depth L <br /> Screen Length (from) 2 —(to) <br /> Well No.: �Z Z Filter Pack (from), <br /> Bentonite (from) <br /> Grout <br /> (to)( <br /> Js?����/k'0. Grout (from) (to) <br /> Inspector: <br /> Drilling rig type <br /> Permit No. OD Auger O.D. I.D. <br /> Completion - Stove pipe/christie box Ccircle one) <br /> Drilling C�omnp'anJy: <br /> Driller: 467 casing <br /> -� Iff T height <br /> Consultant �A1 r " <br /> Geologist ✓ "' AgpyE.GRO0N0 <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. nd Surf �� <br /> Distance to sewer line Cr,o 'sg grout Nb <br /> Domestic well on site - ( y/ n ) ft. <br /> If yes, location and distance - <br /> .1Lft. <br /> _ m <br /> _ m <br /> C <br /> o <br /> SAMPLING •IOC = g` <br /> sac9on <br /> Holding Temperature <br /> Method = <br /> Screening Method <br /> Tracking Sheet - (y/ n ) �y <br /> 7f Ti ft — tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) Z " 111;';1L !�O <br /> Storage Location Casing type <br /> Blank ZZ- fr. Screen S 11- <br /> Slot size OZA <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water i Bags sand/gravel <br /> Mix Ratios Filter Pack type/size Z /Z <br /> Installation Method Surge Block: - (y <br /> (13 <br /> Quantity Installed Discussed with geo ogist: - (y/ n) <br /> Type of method---------- <br /> EH 29 29 CSV. 75' <br />