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M MONITORING WELL INSTALLATION REPOnt <br /> it <br /> Date : �hfa4o<.k ` /` CONSTRUCTION <br /> Premise Address: po l s �""^ �/ Total Depth Ab <br /> Screen Length (from) (to) jQ <br /> Wel] No. : G� ' Filter Pack (from) (to <br /> Bentonite (from) ZS (to) ZG <br /> Inspector: Grout (from) Z(o (to) 3 <br /> � p 9 Drilling rig type <br /> Permit No. 437% ` � O Auger O.D. it) I.D. <br /> n T C Completion - Stove pipe/christie box (circle one) <br /> DrllingComparty: <br /> Driller: 1 L casing <br /> height <br /> Consultant <br /> Geologist /`•`� �— <br /> A80VE-GROUND <br /> COMPLETION LSi1 <br /> C ON <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - ( y (LT) f� <br /> If yes, location and distance - tt' <br /> SAMPLING0 <br /> dottedd c I <br /> 0 section <br /> Holding Tempeyp yetu <br /> viW pack <br /> Method ( — g ' <br /> Screening Method LWAI <br /> Tracking Sheet ( y / n ) _ - <br /> tt. tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - y <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 C <br /> Mix Ratios Filter Pack type/size 3 <br /> Installation Method +,. .Aot <br /> _, . rd Surge Block: - ( y / n ) <br /> Quantity Installed Discussed with geologist: - ( y / n ) <br /> Type of method <br /> EH 29 29 <br />