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MONITORING WELL INSTALLATION REPOT f <br /> Date: //Yl f.) CONSTRUCTION <br /> Premise Addre s: /� /' W f S Total Depth 01—I <br /> �Q L Screen Length (from) 70 (to) lcl <br /> Well No.: l Zl Filter Pack (from) It (to)Bentonite (from) (to) <br /> InspectorGrout (from) g (to) n <br /> :vDrilling rig type <br /> Permit No. 7/ �� Auger O.D. l(� I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: �O� <br /> Driller: casing <br /> height <br /> Consultant If21/)1.,1� <br /> Geologist Dom/( :�C.� W/�`�"� <br /> ABOVE-GROUND CtiAIST'Y-80X <br /> CO WLETCN COW LETICN <br /> J <br /> SPECIAL PERMIT INFO. r J� Ground Surf n <br /> Distance to sewer line �y ^�igrout p <br /> Domestic well on site - ( y/ n ) 0 g <br /> If yes, location and distance - U ft. <br /> ft. <br /> 01 <br /> } = a <br /> _ - o <br /> YY c <br /> o <br /> SAMPLING slotted <br /> sec5cn <br /> Holding Temperature <br /> gnwl pack <br /> Method = <br /> Screening Method r' <br /> Tracking Sheet - (y/ n ) n,l <br /> tL <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT (� <br /> Contamination Noted - (y/ n ) 4WC <br /> Storage Location Casing type <br /> Blank ft. Screen____--------ft. <br /> Slot size 0117 <br /> GROUnNG Bags cement <br /> Buckets bentonite <br /> Depth to water ^ Bags sand/gravel <br /> Mix Ratios Sd° ¢ fY Filter Pack type/size <br /> Installation Method Surge Block: - (y n <br /> Quantity Installed /isL4 Discussed with geo ogist: <br /> Type of method <br /> EH 29 29 <br /> so'`s a <br />