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—MONITORING WELL INSTALLATION REPS-1' <br /> Date: / Z 3 �� 9 CONSTRUCTION <br /> Premise Address: )10/ f- Total Depth <br /> '/�, Screen Length (from) (to) !o <br /> Well No.: V l �-�/ 4- Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> � <br /> Inspector: Grout (from) 61 (to)�— <br /> ���r� Drilling rig type /0�7 <br /> Permit No. 7 Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: V _ casing <br /> 6 height <br /> Consultant <br /> Geologist � Cc.w�l' T <br /> A80VE-GF10UND <br /> CONFLET;ON CH STY4M <br /> COMPLc nCN <br /> SPECIAL PERMIT INFO. G=nd Surfxs <br /> Distance to sewer line Groul <br /> Domestic well on site - ( y n <br /> If yes, location and distanft• <br /> O <br /> • O <br /> <; <br /> SAMPLING •M:. 3 <br /> slotted <br /> Holding Temperature = �: <br /> Method = _ ¢71911 <br /> ; _ <br /> Screening Method ? —_ <br /> Tracking Sheet - (y/ n ) _ <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) x/01 /n <br /> Storage Location Casing type / t l� <br /> Blank !d ft. Screen 25 ft. <br /> Slot size .U Z0 <br /> GROUTING Bags-cement <br /> 5Buckets bentonite / <br /> Depth to water Bags sand/gravel 5 <br /> Mix Ratios '>- Filter Pack type/size <br /> Installation Method Surge Block: - (y n <br /> Quantity Installed Z &---" Discussed with geo -gist: - (y� <br /> EH 29 29 Type of method <br />