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06NITORING WELL INSTALLATION REPO <br /> Date: �/! ��� CONSTRUCTION <br /> Premise Address: / W• Total Depth <br /> Screen Length (fr ) <br /> Well No.: l� Filter Pack (fromm)) �— <br /> Z (t(to) <br /> Bentonite (from) 13 (to) II <br /> Inspector: Grout (from) ll (to) y <br /> D/ Drilling r g type <br /> to <br /> Permit No. <br /> Auger O.D. 15 I.D. <br /> '-/ Completion - Stove pipe/christie box (circle one <br /> Drilling Company: <br /> casing <br /> Driller: height <br /> Consultant �k�� <br /> Geologist ��• / AE&E-GROUND (jrp*LE7�10N <br /> OONFLETION <br /> Grou <br /> SPECIAL PERMIT INFO. ��� nd Su face T— <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) n. <br /> If yes, location and distance - n. <br /> = m <br /> - Y <br /> C <br /> O <br /> tiOtted '� Y' C <br /> SAMPLING radon <br /> Holding Temperature = P <br /> Method — <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS12EVFLOPMENT SSC 4D <br /> Casing type 1 <br /> Contamination Noted - ( y/ n ) p q Y C <br /> Storage Location <br /> Blank15 ft. Screen 1 D h• <br /> Slot size v10rr <br /> GROUTING q(f Bags cement <br /> Buckets bentonite Z- L'�n <br /> Depth to water Bags sand/gravel <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 /> /A-7 acv- 3 <br />