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ij <br /> MONITORING WELL INSTALLATION REPOnf <br /> Date : 2 2-t0/c ) ,L CONSTRUCTION / <br />;I Premise Address : 0C �. Total Depth 'P <br /> Screen Length (from) (00 (to) 5 <br /> Well No. : 1Z -- Filter Pack (from) (pd - (to) <br /> Bentonite (from)�L` �� (to) CW L <br /> Inspector: ^ , Grout (from) (to) O <br /> (�/ 9 Drilling rig type S <br /> Permit No . Auger O.D. g' I .D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> ��'' lX�(,�GCCQ� <br /> Driller:_ t '"1 C`� V [ !/� � casing <br /> height <br /> Consultant <br /> Geologist et*CXC T <br /> ABOVE-GROUND <br /> COAPLETION X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Svf <br /> Distance to sewer line 1 f�bD 0roul <br /> Domestic well on site - ( y / n ) <br /> If yes, location and distance - ft <br /> SAMPLING dotted <br /> on <br /> Holding Temperature <br /> Method = gr"W pack <br /> Screening Method <br /> Tracking Sheet - ( y / n ) <br /> L=—ft. _ Llft. <br /> SPOILS �{p { - Q <br /> Storage Method �SS� (� �C o MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) <br /> Storage Location 07[ de,2�r Su/ 6Ul " Casing type 1 eV c 5 4b <br /> Blank 15 g5 ft. Screen,-5 ft. <br /> Slot size PLO <br /> GROUTING Bags cement_ <br /> Buckets bentonite ���VIA 7V3 LBa <br /> Depth to water /i- 20 Bags sand/gravel V"/) <br /> Mix Ratios Filter Pack type/size ltt <br /> Installation Method Surge Block: - ( y n <br /> Quantity Installed Discussed with geo ogist: - ( y <br /> Type of method <br /> EH 29 29/ <br />