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MONITORING WELL INSTALLATION REPO <br /> Date: 1I�� CONSTRUCTION <br /> Premise Address: ' -C Total Depth <br /> Screen Length (from) (to) <br /> Well No.: W 0 u d2 / ¢ ln Filter Pack (from) (to) <br /> ()� V Bentonire (from) (to) <br /> Inspector. N ^^�Q A Q Iluvv Grout (fro ) (to) <br /> 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 /> j' height <br /> Consultant Russ �� <br /> Geologist RAC O <br /> ABOVE-GROUND CHRLM-BOX <br /> CCMPr E ION COMP-ICN <br /> SPECIAL PERMIT INFO. Ground S�afacs <br /> 0� <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) 'L <br /> If yes, location and distance - fL <br /> p <br /> SAMPLING <br /> alonad _ e <br /> < <br /> Vl l aac'anx`... _ <br /> Holding Temperature _ ¢avd pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) ?. <br /> 1t <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> ContaminationNoted( (y n ) Casing type a S•S• P� <br /> Storage Location <br /> Blank Lo fL Screen 220 ft <br /> Slot size () Ci 2 0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratio Filter Pack type/size <br /> Installation ethod :�&.g-- A A Surge Block: - (y/ an <br /> Quantity Installed Discussed with geologist: - (y/n) <br /> Type of method <br /> EH 29 29 <br />