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MONITORING WELL INSTALLATION REPOnf , <br /> Date. N u.� CONSTRUCTION <br /> Premise Address: 4? f Total Depth <br /> Screen Length (from) (to) Z-5 <br /> Well No.: ?Z• 2 Filter Pack ' " (from) $' (to) Z <br /> Bentonite (from) Z (to) ls� <br /> Inspector' Grout {from) S (to) C <br /> Drilling rig type <br /> Permit No. D�/ 3L Z a Auger O.D. a, <br /> 37 <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> height <br /> Consultant G! � M <br /> Geologist <br /> ABOVt:{ROUND C iR* Y-BOX <br /> COM?LE nN COMPLETION I <br /> SPECIAL PERMIT INFO. mrd Surface <br /> 9rovt <br /> Distance to sewer line �� r <br /> �5 <br /> Domestic well on site - (y ft- <br /> If yes, location and distance - - tL <br /> eft. <br /> SAMPLING <br /> ,e <br /> Pack <br /> Holding Temperature '�•- �.-��- , ',; ` .-. �rsv� <br /> GA-'rlfa : — y <br /> Method •� `� <br /> Screening Method ` <br /> Tracking Sheet n � - <br /> 2S �• — fr. <br /> me <br /> SPOILS A �. . <br /> VLOPMENTr+ � MERI <br /> Storage Method � fc _ y <br /> If <br /> Contamination Noted --(y/n) •`.4 - �' �. w '; <br /> Storage Location n/ �llr� r ` Casing type - <br /> - a;• a. -Blank •-. ft.w Screen__—.:..,— <br /> �� <br /> ta2D'� - � ,� �._ -,�Slot size •� �— <br /> Bags <br /> GROUTING .s:' " '� 4 bentonite_ <br /> Buckets <br /> 4� gravel. <br /> Depth to water Bags sand/ <br /> Filter Pack type/siz <br /> Mix Ratiose ' <br /> Installation Method Surge Block: - (y/ n) ! <br /> Quantity]nstalle ``` :�► "Discussed with geologist:µ- (.y/ n) <br /> - Type of method <br /> • EH 29 29 <br /> !� Rz-- Z,5 d.s,) <br />