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MONITORING WELL INSTALLATION REPMrif <br /> Date: 11'Z O ' oCONSTRUCTION <br /> Premise Address: �a �Sw CZ40o�& Total Depth <br /> Screen Length (from) <br /> Well No. : Filter Pack (from) //S (to) Oz <br /> Bentonite (from) !a 2 (to) <br /> Inspector: A4n Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. SJ I .D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: (/uG O casing <br /> height <br /> Consultant do <br /> Geologist z4x7— <br /> ABOVE-GROUND CiiAlStt-BOX <br /> COMPL1=fbN COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surtxe <br /> ? <br /> Distance to sewer line grout <br /> - <br /> Domestic well on site - ( y 1 tt <br /> If yes, location and distance - (D /D L ft. <br /> ft <br /> _ <br /> SAMPLING <br /> slotted _ c <br /> / q sec�on _ $ <br /> Holding TempWe l <br /> Method _ 9mvel pack_ <br /> Screening Method = " <br /> Tracking Sheet - ( y / n ) <br /> SPOILS <br /> Storage Method �5�" ` MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) 2n _ <br /> Storage Location Casing type <br /> Blank /D - 5 ft. Screen /O ft. <br /> Slot size <br /> GROUTING gBags cement5 f <br /> Buckets bentonite 36 <br /> Depth to water �� Bags sand/gravel <br /> Mix Ratios_ 17 L< q1:: 1rTNe1V — Filter Pack type/size 2/2— <br /> Installation Method Surge Block: - ( y / n ) <br /> Quantity Installed, 5fl b T 3G Discussed with geologist: - ( y / n ) <br /> Type of method <br /> EH 29 29 <br />