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MONITORING WELL INSTALLATION REPOnf <br /> Date: 11(�L�- �Tp' CONSTRUCTION <br /> Premise Address:�YF c J Nw J Total Depth �7 c <br /> Screen Length (from) (to) ?S� <br /> Well No.: W- Filter Pack (from) (to) aC) <br /> Bentonite (from) (to) 3 <br /> Inspector: Grout (from) (to)2_ <br /> '' tt Drilling rig type <br /> Permit No. �o 1 dAuger O.D. I.D. <br /> l m Completion tove pi /christie box (circle one) <br /> Drilling Company,, <br /> Driller: 1�4�.:ftheiing <br /> Consultant <br /> Geologist •- T <br /> ABOVEGROUND CHRZ Y-BOX <br /> COk�LET10N CDMPLEnON <br /> SPECIAL PERMIT INFO. Ground Suixe <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) 1 2 . g. <br /> if yes,location and distance - 3 tL <br /> O <br /> C <br /> SAMPLINGdattnd N' _ <br /> � <br /> tocion '- <br /> Holding Temperature = gravel pads <br /> Method r>y <br /> Screening Method ' = <br /> Tracking Sheet - (y/n) <br /> 2C) e. = 20 » <br /> SPOILS <br /> Storage Method i� ^-S MATERIALS/DEVELOPMENT <br /> Contamination Notled - (y kn <br /> Storage Location Casing type <br /> Blank Ijft. Screen ti S f <br /> Slot size .O2o" <br /> GROUTING Bags cement <br /> ccBuckets bentonite <br /> Depth to water T� k�w Bags sand/gravel <br /> Mix Rados -5 -4- I .0 Filter Pack type/size -44-'�) Sot <br /> Installation Method Surge Block: - Q�V n) <br /> Quantity Installed Discussed with geologist: -(12 n) <br /> Type of method <br /> EH 29 29 <br />