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MONITORING WELL INSTALLATION REPO <br /> Date: le �� 1016 CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) C7 <br /> Well No.: _Ad Filter Pack (from) (to)_ <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) 2- (to) O <br /> �{ Drilling rig type _ <br /> Permit No, Auger O.D. to I.D. <br /> �� yj A Completion - Stove pipe/christie box (circle one) <br /> Drilling Compan �!��--� <br /> Driller: casing <br /> E <br /> Consultant height <br /> Geologist <br /> ABOVE-GROUND <br /> cOWPLETION CNALr <br /> y Box <br /> TT <br /> SPECIAL PERMIT INFO. Ground Surtxa <br /> Distance to sewer line G�j 0 grout <br /> Domestic well on site - (y n 60�Z. ft <br /> If yes, location and distance le,- <br /> 3 ft. <br /> Win. <br /> = o <br /> _ <br /> SAMPLING aloud = _i <br /> a - sac5on <br /> Holding Temperature — vW pyo <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> �0 ft = h. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamim ion Noted - y/ n ) d CI <br /> Storage Location rlr$ Y� �� Casing type <br /> Y' 451" �� Blank fr. Screen_ft. <br /> 1 T ) 7" Slot size . 02,0 <br /> GROUTING '�lBags cement (y <br /> Buckets bentoniteV-•!10 - ^^' 1 <br /> Depth to water Bags sand/gravel 30--� <br /> Mix Ratios � Filter Pack type/size <br /> Installation Method 447 e n ) <br /> Surge Block: - (y/ <br /> Quantity Installed 1. 125 se Discussed with geologist: - (y n I <br /> 3 Type of method <br /> EH 29 29 <br /> 2-1/0/lo / �� <br />