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*MONITORING WELL INSTALLATION REPO <br /> Dale: ,ti 4-2,1.11- <br /> CONSTRUCTION <br /> y7 <br /> Premise Address: >J -51 '� 7 �� Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling <br /> /� A� Completion - Stove pipe/christie box (circle one) <br /> Company: C <br /> }► Driller: 'V " casing <br /> t <br /> height <br /> Consultant <br /> ?' Geologist /Ldlr <br /> ABOVE-GROUND <br /> COM?LETION CHRISTY-80X <br /> SPECIAL PERMIT INFO. G=nd gLxfacv COMPLETION <br /> Distance to sewer line cry <br /> Domestic well on site - (y/ n ) ft <br /> If yes, location and distance - <br /> R. <br /> = m <br /> e <br /> — m <br /> C <br /> SAMPLING = ° <br /> slotted = <br /> wc9on <br /> Holding Temperature <br /> Method Q" Pack <br /> Screening Method = <br /> Tracking Sheet - (y/ n) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios 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 />