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MONITORING WELL INSTALLATION REP <br /> 124111 <br /> Date:41-17 /C CONSTRUCTION <br /> Premise Address: Total <br /> Total Depth �� 2 <br /> Well No.:_ / \ 1 Screen Length (from) r Z (to) /u <br /> Filter Pack (from)_ 7 9 (to) /c z <br /> Bentonite <br /> Inspector: /V � (from) 7 s— (to)� <br /> Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. i0 I.D. <br /> Drilling Company: D V <br /> )„ )(.i,(�'l 1 Completion - Stove pipe/christie box (circle one) <br /> Driller:Aiitt dyv" casing <br /> Consultant <br /> height <br /> �"�✓5 <br /> Geologist �Crz7f i.rQ/ 37 T <br /> ABOVE-GROUND <br /> COWPLEfION CHRZTY43OX <br /> SPECIAL PERMIT INFO. CCMPLE71CN <br /> Ground Solace <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - ft. <br /> ft _ft. <br /> m <br /> — o <br /> m <br /> SAMPLING sloctad — c <br /> &,*cion <br /> Holding Temperature <br /> Method — QMVWPaCR <br /> Screening Method <br /> Tracking Sheet - (y/ n ) _ <br /> n. IF = n <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) VC <br /> Storage Location Casing type <br /> Blank--,! ' fr. Screen Zc g, <br /> Slot size 10/0 <br /> GROUTING Bags cement <br /> Buckets bentonite <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 /> EH 29 29 Type of method <br />