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f OONITORING WELL INSTALLATION REP <br /> Date:—"--o4� 70 //' CONSTRUCTION <br /> Premise Address: S Clc1u Total Depth <br /> Screen Length (from) Z (to) 115 <br /> Well No.: Filter Pack (from) T57 13 <br /> Bentonite (from) lei—(to)—I <br /> Inspector: Grout (from) 66 (to) L <br /> Drilling rig type <br /> Permit No. Auger O.D. 1#5 I.D. <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant � <br /> 7 <br /> Geologist " <br /> ABOVE-GROUND C <br /> COMPLETION N <br /> SPECIAL PERMIT INFO. Ground Surf'°' <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) 11 g. <br /> If yes, location and distance - ''// /3 n. <br /> - <br /> = m <br /> SAMPLING slched - i�. <br /> sadon — S <br /> Holding Temperature = yrawl pads <br /> Method = <br /> Screening Method = = <br /> Tracking Sheet - (y/ n ) 25 <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank I S ft. Screen l a ft. <br /> Slot size Id <br /> GROUTING Bags cement 5t Zrz <br /> Buckets bentonite 'I <br /> Depth to water Bags sand/gravel 350'6 <br /> Mix Ratios Filter Pack type/size �3 <br /> Installation Method Surge Block: - (y CD <br /> Quantity Installed Discussed with geo st: - <br /> Type of method ��JJ <br /> EH 29 29 <br /> 6 -2, - <br />