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`MONITORING WELL INSTALLATION REPCh-r' <br /> S�'; r <br /> Date: <br /> i� / <br /> p /- CONSTRUCTION <br /> Premise Address:. 0 G � (1'��2 TTotal Depth 70 a �S ���7� <br /> Screen Len from <br /> Well No.: (from) (to) <br /> Filter Pack (from) (to) <br /> ���Q Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Permit No. <br /> 13 V,?2- Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company: <br /> P7- Completion - Stove pipe/christie box (circle one) <br /> Driller: casing <br /> height <br /> Consultant/LAW <br /> T <br /> Geologist_LAW-f, 71T <br /> ABOVE-GROUND <br /> COMPLETION CHRISIY480X <br /> SPECIAL PERMIT INFO. Ground Surface COMPLETION <br /> Distance to sewer line U"��y td� grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft' <br /> C� qr — <br /> i <br /> — c <br /> SAMPLING slotted c <br /> aac�on ^? <br /> Holding Temp tore l/ —_ <br /> gravel <br /> Method Pack <br /> Screening Mef5od <br /> Tracking Sheet <br /> SPOILS 3tM 6 <br /> Storage Method 0 MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y Un <br /> Storage Location Casing type k1 Q <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> / Buckets bentonite <br /> Depth to water �S 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 /> r1j- <br /> 9 7 <br />