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MONITORING WELL INSTALLATION REP�� <br /> Date: f �` CONSTRUCTION <br /> � .. i <br /> Premise Address: � S Total Depth. y <br /> Screen Length (from) —7 L) (to) <br /> Well No.: ���► 1.(1 Filter Pack (from) 0 (to) Cl <br /> Bentonite (from) Lt (to) <br /> Inspector: Grout (from) (to) �u.' c-cam, <br /> Drilling rig type - <br /> Permit No. Auger O.D. I.D. <br /> r ^�bo �� r; �1 Completion - Stove pi -7 <br /> Completion bo c circle one) <br /> Drilling Company: (/`J /, <br /> Driller: casing <br /> Theight <br /> Consultant t � V <br /> -aw, <br /> Geologist t'A VC -c'�/\/ -- <br /> ABOVE-GROUND CHRIST 4M <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sumac: <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) (4 ft <br /> If yes, location and distance - 49 ft. <br /> _= c <br /> o <br /> SAMPLING sloriod = <br /> socdon <br /> Holding Temperature = grx„d pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank cf[� ft. Screen ��­G ft, <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios S Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed 1 4, Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br /> 6 <br />