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' 140NITORING WELL INSTALLATION REPOnI' <br /> Date: IZZ7L vl� �;Yl / CONSTRUCTION <br /> Premise Address: ��`1� �/' ���^� Total Depth <br /> Screen Length (from) 2 (to) 15 <br /> Well No.: ' Filter Pack (from) 2-5 (to) 11P <br /> Bentonite (from) I`> (to) t� <br /> Inspector: Grout (from) tl (to) y <br /> Drilling rig type <br /> Permit No. 53 Auger O.D. 1:5 _ I.D. 4- <br /> Drilling <br /> Drilling Company: <br /> Vic Completion - Stove pipe/christie box (circle one) <br /> Driller: A4-1 Y casing <br /> // -- height <br /> Consultant <br /> lir <br /> Geologist /180VE GROUND <br /> COMPGROUN CHR* Y4= <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Grourd Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - Alltt, <br /> _ m <br /> _ F <br /> O <br /> C <br /> 1. 0 <br /> SAMPLING dotted <br /> on _ <br /> Holding Temperature pn s pads <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> tt. tt• <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type /! <br /> Blank jt5ft. Screen ,6Q fr• <br /> Slot size <br /> GROUTING Bags cement l/ <br /> Buckets bentonitey <br /> Depth to water Bags sand/gravel 7 <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 /> 6, � Z< �� �� ��� Z <br />