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i <br /> MONITORING WELL INSTALLATION REPOnf <br /> Date:��/ f �/ 2�L 1 CONSTRUCTION <br /> Premise Address : Total. Depth <br /> Screen Length (from) 30 (to) /0 <br /> UE / T <br /> Well No. : � Filter Pack (from).(to) <br /> to <br /> Bentonite (from)_ (to) 7 . <br /> Inspector: p p 9 Grout (from) (to) 3 <br /> j3 s)eZ6 / !s3 <br /> Drilling rig type <br /> Permit No. Auger O.D. k I.D. <br /> Completion - Stove pipe/christie box circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height t ZIt <br /> Consultant ' <br /> Geologist <br /> ABOVE-GROUND CNAISTY-BOX <br /> COMPLETION <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Surface <br /> Distance to sewer line �� 3 Grout <br /> Domestic well on site - ( y / n ) <br /> If yes, location and distance - �' <br /> 16 <br /> SAMPLING slotted = c <br /> an <br /> Holding Temperature <br /> Method Grafi pack <br /> Screening Method = <br /> Tracking Sheet - ( y / n ) <br /> 3o n. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n 0 <br /> Storage Location OW Casing type 2 <br /> Blank 10 ft. Screen fr. <br /> Slot size 20 • <br /> GROUTING Bags cement Z .4CC = /7i - <br /> Buckets bentonite Z Gag weZz <br /> Depth to water C D Bags sand/gravel <br /> Mix Ratios a / ✓ Filter Pack type/size 3 <br /> Installation Metho Surge Block: - ( yrs, <br /> Quantity Installed 3 Grr Discussed with geYog'st: - ( y <br /> Type of method <br /> EH 29 29 <br /> l�,a 6 <br />