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f <br /> MONITORING WELL INSTALLATION REP--`-T <br /> Date: CONSTRUCTION-- - -- f /-� <br /> �t G k0L Total Depth [ �—A <br /> ZC� <br /> ?remise Address:— -- <br /> Sween Length ([soot) (to) <br /> Well No.: Fye i(" Bter Pack (from) (to) <br /> Bentonite (from) (to) <br /> ' SInspector. `,� Grout (from) Cto) <br /> , <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D• <br /> .3 lesion - Stove pipe/ tie box (circle one) <br /> Drilling Company: <br /> Driller, height <br /> Consultant <br /> r <br /> Geologist�� VE-GROUND \\ <br /> C^•l,�P'�TSON CNAIS'i'Y'-acX <br /> ? CCl.Ap=-1 JCN <br /> SPECIAL PERKT INFO. <br /> _ s <br /> cut <br /> Distance to sewer line 1 q <br /> Domestic well on site - C y/ n ) It- <br /> [f yes, location and distance - t <br /> D nsL bar 01>1 — . <br /> a <br /> SAMPLING ©� :lacurd <br /> I-loldingTemperature <br /> Method — <br /> Screening Method (V <br /> Tracking Sheet - ( y n ) +� <br /> ♦ -� ff. <br /> SPOILS <br /> Storage Method <br /> MATERIALS/OEVELOPN ENT <br /> Contamination Noted - (y Cn S <br /> Storage Location J Blank type fr- Screen - <br /> p }- Slot size <br /> GROUTING / f t E U Bags cement <br /> r `f ckets OentoniC@ <br /> Depth to water 1 Bags sand/gravel <br /> Mix Ratios r Fater Pack type/size <br /> Installation Method 1A#I;,(> Surge Block: - C y <br /> Quantity Installed Discussed with geologist: - C y/ n) <br /> Type of merhod <br /> F.H 29 29 <br />