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',,,)NITORING WELL INSTALLATION REPO <br /> Date: ✓ CONSTRUCTION <br /> c{ I l�� �� Total Depth `s <br /> Premise Address: -° Screen Length (from L14 (to) 10► <br /> Well No.: �� W rn �� Filter Pack (from)�I 7 (to) I <br /> Bentonite (from) -(to) <br /> Inspector. Grout (from)_.11' ' (to) <br /> aLIAJ DrMing rig type <br /> Permit No. Auger O.D. I a " I.D. <br /> Completion- Stove pipe/ tie box circle one) <br /> Drilling Company: <br /> casing <br /> Driller. height <br /> V <br /> Consultant -�• <br /> Geologist '- <br /> i180VE-GRCUND p-MSTY-30X <br /> CO&PLE ION CpMPLE ON <br /> SPECIAL PERMIT INFO, Ground Sisfa= <br /> grout <br /> Distance to sewer line l f <br /> Domestic well on site - (y/ Z_`�" ft. <br /> If yes, location and distanteV )1— fL <br /> .1J,_...it. <br /> V_ _ <br /> is �- • <br /> — O <br /> SAMPLING tlara.� <br /> sac:cn <br /> Holding Temperature Pack <br /> Method '` <br /> Screening MethodCP <br /> Tracking Sheet - (y/ n) � <br /> ft. ft. <br /> SPOILS 2 L` + l' <br /> J MATERIALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted- (y/t)) <br /> v� <br /> Storage Location Casing e <br /> Blank ' ft. Screen 2 ft. <br /> Slot size �r' <br /> GROUTING Bags cemenBuckets ben <br /> Depth to water �� Bagssand/ <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 />