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-41ONITORING WELL INSTALLATION REI'd <br /> Date: q CONSTRUCTION <br /> T ^� 6 <br /> Premise Address: /S� Total Depth <br /> Screen Length (from) Y (to) 2% <br /> Well No.: Zy Filter Pack (from) (to) <br /> Bentonite (from) (to) to <br /> Inspector: Grout (from) (to) <br /> d� Drilling rig type S <br /> Permit No. / Auger O.D. I.D. <br /> l �e Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: (�L'-�_� <br /> Driller: 70- casing <br /> height <br /> Consultant � <br /> Geologist �K <br /> %Gs1C LAk* 't r'✓" ABOVE-GROUND CNRISTY80X <br /> ✓✓ COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfacs <br /> Distance to sewer line grout <br /> Domestic well on site - (y *2� <br /> tt. <br /> If yes, location and distance - / ft. <br /> / n. <br /> — a <br /> = m <br /> — c <br /> SAMPLING slotted <br /> ssaon = <br /> Holding Temperature ✓ { <br /> VAYW Pack <br /> Method = <br /> Screening Method = <br /> Tracking Sheet - (y/n ) �q <br /> / / 2 ft.4 <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ Zr/ <br /> Storage Location Casing type <br /> Blank ft. Scre n fr. <br /> Slot size .620" <br /> GROUTING Bags cement <br /> Buckets bentonite T rw <br /> Depth to water �3 Bags sand/gravel ? <br /> Mix Ratios !t o+� ' &0* - o-449 Filter Pack type/size i 3 <br /> Installation Method rr Surge Block: - (Pn ) <br /> Quantity Installed Discussed with geologist: - Cy <br /> Type of method <br /> EH 29 29 <br />