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MONITORING WELL INSTALLATION REPOn f <br /> Date: o g CONSTRUCTION <br /> Premise Address: 535 G"ka-e— Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> �-Q Drilling rig type <br /> Permit No. / — Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant �� <br /> EW7 7F <br /> Geologist <br /> ABOVE-GROUND CHRISTY480X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - y 1 n ) 6 <br /> ' ft. <br /> If yes, location and distance - - i ft. <br /> ft. <br /> C <br /> SAMPLING slotted <br /> • section = <br /> Holding Temperature G <br /> Method <br /> —_ Imp Pack <br /> Screening Method <br /> Tracking Sheet - n ) <br /> t6y Igo <br /> ft. <br /> SPOILS <br /> Storage Method � � MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) �<< <br /> Storage Locatiori Cn_-� Casing type <br /> Blank ft. Screen ft. <br /> GROUTING <br /> Slot size_ pJ,p <br /> / Bags cement <br /> Or Buckets bentonite <br /> Depth to water b0 Bags sand/gravel_ t_ <br /> Mix Ratios_ Q� ( ZAt- Cn r Filter Pack type/size 9 <br /> Installation Methods w, hilrA Surge Block: - (y/ n) <br /> Quantity Installed Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method <br /> �� .�A W - << u37• 9, <br />