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MONITORING WELL INSTALLATION REPOn f <br /> Date: CONSTRUCTION <br /> Premise Addre �� Total Depth 5 <br /> Screen Length (from) (to) 3'f <br /> Well No.: � � Filter Pack (from) (v`7 (to) 3> <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) 2 (to) " IV <br /> Drilling rig type <br /> Permit No. Auger O.D. 2i I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:__// <br /> Driller: AIC4 casing <br /> height <br /> Consultant QA G,/ <br /> Geo g1111 <br /> ist 4--- /K� <br /> /ABOVE-GROUND <br /> COMPLETION COMPLETICMPLE 10X <br /> O <br /> SPECIAL PERMIT INFO. Ground Surf act <br /> Distance to sewer line -50 proof <br /> Domestic well on site - (y A(D 2q- It <br /> If yes, location and distance - <br /> 3� n. _ n. <br /> C <br /> SAMPLING <br /> slotted _ <br /> Bacton = B <br /> Holding Tempera "_ <br /> Method ��Pack <br /> Screening Method <br /> Tracking Sheet n ) — s <br /> SPOILS <br /> Storage Method �� MATERIALS/DEVELOPMENT <br /> Contamination Noted - / n ) it V(2- <br /> Storage <br /> Storage Location 0A Casing type L <br /> Blank 35 ft. Screen ft. <br /> Slot size 109 0/d <br /> GROUTING Bags cement_-ti-u7 (/ <br /> Buckets bentonite e <br /> Depth to water Bags sand/gravel 2 <br /> Mix Ratios 3 L�qw hocri 7-1W /I �t�c 3l�t l.G� Filter Pack type/size uA -- <br /> Installation Method Surge Block: -©n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />