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0 0 <br /> MONITORING WELL INSTALLATION REPOnf <br /> Date: 11ig0/s- //Tits / CONSTRUCTION <br /> Premise Address: �� r W - g(A � Total Depth Z (0 <br /> Screen Length (from) Z Co (to) <br /> Well No.: Filter Pack (from) (47 _(to) <br /> Bentonite (from) <br /> Inspector: Grout (from) (to) <br /> o 5�2 90'9 Drilling rig type h <br /> Permit No. Auger O.D. If I.D. <br /> Completion - tove pip Christie box (circle one) <br /> Drilling Company: �y <br /> Driller: VG=roundSurf <br /> Consultant <br /> �d�QGeologist <br /> CHRZrY-BOXCOMPLETON <br /> SPECIAL PERMIT INFO. <br /> Distance to sewer line y SD r grout <br /> Domestic well on site - (y /2—. ft. <br /> If yes catio and� d' e - / ft•.cee �r ��)P� •�6 -ice tea. _ <br /> = m <br /> _ e <br /> _ m <br /> — o <br /> SAMPLING slotted <br /> asc.on —_ <br /> Holding Temgravel pack <br /> Method <br /> Screening Method NO = <br /> Tracking Sheet - n ) <br /> 2-(o <br /> SPOILS <br /> Storage Method � � — MATERIALS/DEVELOPMENT <br /> Contamination Noted - (yon PVC— <br /> Storage Location Casing type T P <br /> Blank I fr. Screen IU ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite ' <br /> Depth to water Bags sand/gravel Z t— <br /> Mix Ratios 2,11rtpt /5 Filter Pack type/size Y <br /> Installation Method /909—2)::r T:ESurge Block: - (y AO <br /> Quantity Install d �— Discussed with geologist: - ( yCn <br /> Type of method <br /> EH 29 29 / �" <br /> 1• 12 • & Nati/- i "Tc�/ ll <br />