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MONITORING WELL INSTALLATION REPT <br /> v Jnr <br /> Date: p� L CONSTRUCTION <br /> Premise Address: /J f{// d �JV ( iD✓ Total Depth 100 <br /> Well No.: W /S Screen Length (from) 100 (to) a <br /> Filter Pack (from) Ru (to) <br /> f/_ p Bentonite (from) (to) <br /> Inspector: 6���1 Grout (from (to) <br /> Drilling rig type 6A 0 <br /> Permit No. Auger O.D. /0' I.D. 11 a( <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant C�b./t.�c� <br /> Geologist ?&', 7,4k r'4 _ \ T <br /> ABOVE-GROUND \ <br /> OC&PLETION CHRSTY BOX <br /> rafi O <br /> SPECIAL PERMIT INFO. Gsu"ri <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n) <br /> If yes, location and distance - <br /> Q � a <br /> C <br /> SAMPLING cloned <br /> aqp section <br /> Holding Temperature <br /> Method 1?naw• _ gr'�w Pack <br /> Screening Method 7,� r'd — <br /> Tracking Sheet w n ) ` <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/(n)Storage Location �t oQ! �4 Casing type 7`///r/' / <br /> U b s(i� SO <br /> QQ / Blank `f I fr. Screen d fr. <br /> Slot size 0. 0 2-0 <br /> GROUTING Bags cement SN <br /> i Buckets bentonite_ <br /> Depth to water Bags sand/gravel 3 <br /> Mix Ratios / Filter Pack type/si�- (y <br /> Installation Method ,env Surge Block: - (yQuantity Installed Discussed with ge ) <br /> Type of method �J <br /> EH 29 29 <br />