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"-'MONITORING WELL INSTALLATION REPOT <br /> Date: CONSTRUCTION <br /> Premise Address: 'Z25 S Total Depth <br /> Screen Length (from (to) /Z5 <br /> Well No.: V W J Filter Pack (fro) �Eil(to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from)_ /2_ (to) <br /> 1 Drilling rig type CA-((,� <br /> Permit No. ��l Auger O.D. /-0. 2, I.D. . 2S <br /> � �'i�7 � Completion - Stove pipe/christie box (circle one) <br /> Consultant "� <br /> Geologistl�-tC' Pxu�C +tIck-up <br /> SPECIAL PERMIT INFO. <br /> ABOVE-GROUND CHRISTY43OX <br /> Distance to sewer line <br /> —jiCaArSPLE7fON COMPLETION(•' <br /> Domestic well on site - (y/Z i) Suciaca <br /> If yes, location and distance - grout <br /> ft. <br /> • ft. <br /> ft. <br /> SAMPLING <br /> Holding Temperature JbC' d°twd <br /> Method6ndal 1 CL0" — <br /> H <br /> Screening Method grawi pack <br /> Tracking Sheet - n) _ <br /> •:X <br /> SPOILS <br /> Storage Method PLA—mL MATERIALS/DEVELOPMENT <br /> Contamination Notes - (y 4(DH n , <br /> Storage Location (YA 5 31 IV– Casing type_ 5ul C <br /> Blank LJ ft. Screen <br /> Slot size 02.0 <br /> Bags cement In )GAS <br /> GROUTING Buckets bentonite J 8"_e6_' <br /> Bags sand/gravel <br /> Depth to water �.1�aas— Filter Pack type/size_ 2 1Z- <br /> Mix Ratios qL 0't4Surge Block: - (y/ rf <br /> Installation Method "1 pku, Discussed with geologist: - (o n ) <br /> Quantity Installed (116 6� Type of method <br />