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MONITORING <br /> NITORING WELL INSTALLATION REPO <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> �f ro lG�oo� l o�,�ye Screen Length (from) 3 (to) <br /> Well No.:1'p'/ Filter Pack (from) (to) <br /> Bentonite (from) I (to)141 <br /> Inspector: Grout (from) t') (to) 5•5 <br /> a�/95Drilling 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 /> 0 <br /> Geologist °` ��� <br /> ABOVE-GRCUN <br /> COMPLETION *-ry 03f— <br /> P <br /> SPECIAL PERMIT INFO. xuueb ---- <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - <br /> 5 n. a. <br /> = m <br /> — o <br /> SAMPLING slotted = { <br /> section — - <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS _ <br /> Storage Method_ �Gct lz Ll/C!!l a MATERIALS/DEVELOPMENT <br /> Contamination Noted ( y/ n ) 2 ii <br /> Storage Location Casing type <br /> Blank /:% fr. Screen 110ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water ~/V Bags sand/gravel_ <br /> Mix Ratios Filter Pack type/size (2 <br /> Installation Method—AAM Surge Block: - (y/ n ) <br /> Quantity Installed / Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />