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MONITORING WELL INSTALLATION REPOn i <br /> Date: IUPC 1 CONSTRUCTION �L <br /> Premise Address: els°� �� 1 Total Depth 2 - <br /> 0 C. <br /> Screen Length (from) 5 c E (to) G <br /> Well No.: W — Filter Pack (from) (to) <br /> Bentonite (from) Z (to) <br /> Inspector: Grout (from) �(to) <br /> Drilling rig type <br /> Permit No. ST (--)C/—I d6- Auger O.D. I.D. <br /> Drilling Company: <br /> Completion Stove pipe Christie box (circle one) <br /> �� � �c��^e <br /> Driller: casing <br /> Sight <br /> Consultant ��VlS e CSC � Z <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION CHRISTY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surlaca <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes,location and distance - Z ft. <br /> S ft. <br /> ft. <br /> — m <br /> SAMPLING to \ Maned <br /> &#don <br /> Holding Temperature = GiW Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) __ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination No ed - (y <br /> Storage Location_k..r a Casing typed YUC l <br /> Blank ft. Screen l fl <br /> Slot size C�•nzs� " <br /> GROUTING Bags cement l <br /> Buckets bentonite 1 <br /> Depth to water rD �k` S "CO "� Bags sand/gravel <br /> Mix Ratios ti U/ b--5 Filter Pack typesize <br /> Installation Me od Surge Block: - CyDl n) <br /> Quantity Installed Discussed with geologist: - (D(n) <br /> Type of method <br /> EH 29 29 <br />