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Gam/ <br /> MONITORING WELL INSTALLATION REPOxf <br /> I <br /> Date: � &/D CONSTRUCTION <br /> Premise Address : �� / S C � — Total Depth I?A <br /> Screen Length (from) (to) 9 <br /> Well No. : Filter Pack (from) / (to) 104 <br /> Bentonite (from) ! o(o (to) !0 2- <br /> Inspector: Grout (from) /11 y (to) 3 <br /> C-� QDrilling rig type <br /> Permit No. cTF �C (O D5 Auger O.D. /0 I.D. G� <br /> Drilling Company: /� � E Completion - Stove pipe/christie box (circle one) <br /> � e <br /> Driller: 9W f Z casing <br /> E height <br /> Consultant <br /> Geologist <br /> ABOVE-GROUND <br /> 00MPLErON (tE#T <br /> SPECIAL PERMIT INFO. Ground g <br /> Distance to sewer line 4 SO "rout <br /> Domestic well on site - ( y77 n ) <br /> If yes, location and distance - /d 6 <br /> ft. <br /> ft. <br /> _ <br /> SAMPLING <br /> slotted = ,� <br /> cd an <br /> Holding Temperature <br /> Method = gsvel Pa <br /> Screening Method = _ <br /> Tracking Sheet - ( y / n ) <br /> ft. <br /> SPOILS X20 <br /> Storage Method /at 4*40 e&,44� MATERIALS/DEVELOPMENT <br /> Contamination Noted - n ) T rc �Vn <br /> Storage Location Casing type c� <br /> Blank /09 ft. Screen Zj ft. <br /> Slot size 030 <br /> GROUTING Bags cement 3 t�? 9f/d� ce i <br /> Buckets bentonite oZ A"- "b� 7`lr • 7 0 <br /> Depth to water O=W Bags sand/gravel S s @ /ero" -ev, <br /> Mix Ratios .35 a Q t Filter Pack type/size # 3 <br /> Installation Method 70 <0 U �e.FA,n,,.,,f Surge Block: - ( y L'J <br /> Quantity Installed iz Discussed with geologist: - ( y <br /> Type of method <br /> EH 29 29 <br />