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MONITORING WELL INSTALLATION REPOnf <br /> rr <br /> Date: CONSTRUCTION <br /> Premise Address : Total Depth <br /> Screen Length (from) (to) <br /> Well No. : i�` / B /aQ �� Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. 31L Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> t ID <br /> Driller:_/.K�(i[" f f F casing <br /> /- � o <br /> TV height - <br /> Consultant /ac f/ �G <br /> 1 <br /> Geologist C�� l�'�-� <br /> ABOVE-GROUND <br /> aw <br /> COMPLETION CNAISfY-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - ( y / n ) 1 ft <br /> If yes, location and distance - ft <br /> SAMPLING slotted 4 c <br /> "C4on — - ' <br /> Holding Temperature <br /> erature <br /> vel <br /> Method — � Pack <br /> Screening Method = <br /> - - <br /> Tracking Sheet - — <br /> Y n — <br /> ft. _ ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) <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 <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y / n ) <br /> Quantity Installed Discussed with geologist: - ( y / n ) <br /> Type of method <br /> EH 29 29 <br />