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"'iv'PONITORING WELL INSTALLATION REPOn� <br /> Date: CONSTRUCTION <br /> Premise Address: S3S Total Depth <br /> Screen Length (from) (to) I <br /> Well No.: V 3 Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. S� Auger O.D. $ I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: rot-��G�� <br /> Driller: �GG( t ' casing <br /> height <br /> Consultant _ Ir7 <br /> - <br /> Geologist �G ti •- <br /> ABOVE-GROUND CNRtS'TY-80X <br /> COMPLETION PLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site -G7 n ) ���U ' N 1 4- ft• <br /> If yes, location and distance - <br /> 1fl•gft. <br /> zi. C <br /> SAMPLING slotted = Z B <br /> socdon <br /> Holding Temperature = P <br /> ack <br /> Method _ <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) _ <br /> �.8 ft. ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted n ) <br /> Storage Location y NU� D, �'�O Casing type <br /> Blank ft. Screen ft. <br /> Slot size -430 <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 /> 7' 30 •o 8 vel/ 3 <br />