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MONITORING WELL INSTALLATION REPOnf <br /> Date:_TS CONSTRUCTION <br /> Premise Address: / Total Depth 5 <br /> Screen Length (from) 2 (to) <br /> Well No.: l ��R^Y°� Filter Pack (from) 2`7 (to) 3 <br /> Bentonite (from) 3 (to) l <br /> Inspector: Gfent-CattAs4fr'om) i (to) CJ <br /> JJ Drilling rig type <br /> Permit No. 0b qt)-1121 Auger O.D. g I.D. <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: f— / casing <br /> height <br /> Consultan -C20 <br /> Geologist ABOVE GROUND <br /> 00WLE'r;0N COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surt"~ —+—- <br /> OrU C�c� <br /> Distance to sewer line <br /> Domestic well on site - n) �►f 1 ► $- <br /> If yes, location and distance - 5 ft <br /> .ft. <br /> _ e <br /> o <br /> SAMPLING <br /> N/� sacdon = <br /> Holding Temperature c+��Tvu� = yrawl pack <br /> Method �� ���7 <br /> Screening Method r' <br /> Tracking Sheet - n ) <br /> i—fL <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) L" <br /> Storage Location Casing type crit 7� <br /> Blank ft. Screen--------fl- <br /> Slot <br /> creen ftSlot size C 7�0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios N Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br /> 72�- `l0 W <br />