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MONITORING WELL INSTALLATION REPOnf <br /> Date: ` 0-3 CONSTRUCTION <br /> Premise Address: &Z'418 -- Total Depth <br /> Screen Length (from) 7-'D (to) S <br /> Well No.: �z ' f Filter Pack (from) 7,2,- _(to) <br /> Bentonite (from) (to) <br /> Inspector: - Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Z Auger O.D. F.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: 7- 'r casing <br /> . � <br /> Consultant height <br /> Geologist ABOVE-GROUND <br /> COMPLETION CtiRtSTY-SOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Grourd Sw1we <br /> �b, grout <br /> Distance to sewer line <br /> Domestic �- <br /> well on site - (y 4CD <br /> If yes, location and distance - ft- <br /> ft. <br /> wt . <br /> 0 <br /> SAMPLING slotted <br /> sacdon = <br /> HoldingTemperature � � ,: — �"DI l� <br /> - : <br /> Method cS' Aix <br /> Screening Method <br /> Tracking Sheet n ) moo : <br /> SPOILS <br /> Storage Method - f '�`� _ y� MA'�� LOPME1N/T <br /> Contamination Noted - n ) Casing type <br /> Storage Location 41A,1- Blame ft! Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Z 3 Bags sand/gravel <br /> s Filter Pack type/size <br /> Mix Ratio <br /> Installation Ratios Method Surge Block: - (y <br /> Quantity Installed Discussed with geologist: - {y <br /> Type of method <br /> EH 29 29 <br />