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MONITORING WELL INSTALLATION REPOke <br /> Date: 00g+ W CONSTRUCTION <br /> Premise Address: 3Jr35 (- '"� Total Depth <br /> Screen Length (from)_ 2 _(to) <br /> Well No.: �' Filter Pack (from) 2$4 (to) 5 <br /> Bentonite (from) 5 (to)� <br /> Inspector: Grout (from) q (to) <br /> Drilling rig type 0*4s <br /> Permit No. ` Auger O.D. /O I.D. (o <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: , <br /> Driller: f casing <br /> height <br /> Consultant T7 T <br /> Geologist <br /> ABOVE-GROUND CtiAIM43OX <br /> COMPLETION OMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface ��— <br /> � proof <br /> Distance to sewer line _ <br /> Domestic well on site - y ) .� 150 ��� _�ft. <br /> If yes, location and dista e - g ft- <br /> �ft. <br /> = 4. m <br /> SAMPLING slcttad — c <br /> Holding Temperature = grays,P <br /> ack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n ) �Q �jir PY <br /> Storage Location J Casing type 7 G <br /> Blank 10 ft. Screen <br /> Slot size <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 /> Type of method <br /> EH 29 29 <br />