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J MONITORING WELL INSTALLATION REPOxi <br /> Date : /mac IP/JiJ /O b /1 CONSTRUCTION <br /> Premise Address : 40 13 W. e. -t 10 A OfL Op� Total Depth 6c � <br /> Screen Length (from) (to) <br /> Well No. : Filter Pack (from) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type CLLR <br /> Permit No. ` U Auger O.D. I .D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: (i/IAZZ1 //C/oc� casing <br /> height <br /> Consultant /n/ ,� <br /> Geologist <br /> (Ncr " <br /> ABOVE-GROUND <br /> COMPLETION CHRISTY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO, Ground Surface <br /> 7 <br /> Distance to sewer line grout <br /> Domestic well on site - ( y n ) Xz <br /> ft <br /> If yes, location and distance - <br /> _ a <br /> _ <br /> SAMPLING = g <br /> slotted <br /> sec on <br /> Holding Temper e <br /> o _ Gn Pad <br /> Meth d <br /> Screening Metho�h <br /> Tracking Sheet - n <br /> ft. — ft. <br /> SPOILS <br /> Storage Method k� 10(5 6= MATERIALS/DEVELOPMENT <br /> Contamination Noted - If / <br /> Storage Location �Q W Casing type 2 V <br /> Blank !:q6 ft, Screen <br /> Slot size ( ' <br /> GROUTING Bags cement <br /> ( Buckets bentonite wi d r <br /> Depth to water S Bags sand/gravel <br /> Mix Ratios qfo -F- ) Filter Pack type/size <br /> Installation Method MR4- r*AA� Surge Block: - ( y n <br /> Quantity Installed Discussed with geo ogist: - ( y n ) <br /> Type of method <br /> EH 29 29 <br /> 6/2./7 6 /Wl1 <br />