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MONITORING WELL INSTALLATION REPOnf <br /> Date: Zur�T CONSTRUCTION <br /> Premise Address: �J31 t �y 3 b0 Total Depth 31 <br /> Screen Length (from) 30 (to) 15 <br /> Well No.: / M W 'Jr rer Pack (from) 3% (to) 13 <br /> Bentonite (from) 1'S (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type_i, e <br /> Permit No. _ F / T7 Q ! �- Auger O.D. 10 I.D. o <br /> /� Q00hei.g <br /> /christie box (circle one) <br /> Drilling Compnan1y:� � �/ // <br /> Driller: (�� t lLLf.� g <br /> tConsultant Iff.T <br /> GeologistCtIA7STY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line ' Grout <br /> Domestic well on site - (y n �� n <br /> If yes, location and distance - n <br /> = m <br /> — m <br /> _= c <br /> — o <br /> SAMPLING slortad _ B <br /> -r secdon �- <br /> Holding Temperature /V = Vivig pack <br /> Method = <br /> Screening Method < <br /> Tracking Sheet - ( y/ n ) <br /> G� SPOILS L— jj <br /> M1I FGtT <br /> S� torage Method _I MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y 1<9— - PSC <br /> Storage Location Casing type _I <br /> Blank 15 ft. Screen t ft. <br /> Slot size . 010 <br /> GROUTING Bags cement <br /> I t Buckets bentonit ltSr P44i <br /> Depth to water ,�`� Bags sand/ el "IZ e <br /> Mix Ratios Filter Pack type/size li <br /> Installation Method Surge Block: - (y nn <br /> Quantity Installed Discussed with geoTogist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br /> q- 27-P R/- S <br />