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MONITORING WELL INSTALLATION REPOnf <br /> Date: / CONSTRUCTION t+ <br /> Premise Address: �// / �kL� \ Total Depth <br /> ,, Screen Length (from) <br /> Well No., MW/N, Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. lJ Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: iLG(l / - <br /> Driller: -wJoi4 Ilea. `cs4tOOWLETIC <br /> ca Ing <br /> he' ht <br /> Consultant <br /> Geologist �^ <br /> C-S SiY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Solace <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) n. <br /> If yes, location and distance - n, <br /> 1bn. <br /> = m <br /> — o <br /> — m <br /> = c <br /> — o <br /> SAMPLING dotted _ <br /> &*tion <br /> Holding Temperature gravel pxk <br /> Method <br /> Screening Method = <br /> Tracking Sheet - (y/ n) <br /> n. = n <br /> �'pu SaGd�tia 5 <br /> SPOILS Z� <br /> Storage Method MATERIALS/9EVELOPMENT'r 3 <br /> Contamination Noted - (y/ n) l�" PJC OI d X11't3 <br /> Storage Location Casing type <br /> Blank ft. Screen__—. L� ft• <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bagssand/ <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 /> te 011 <br />