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'14I0NITORING WELL INSTALLATION REPOY <br /> Date:_ Z� T CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) O <br /> Well No.: LK/ �Z Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) O <br /> Drilling rig type <br /> Permit No. �t� Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: OLC <br /> Driller:___. f casing <br /> a height <br /> Consultant � / �j� <br /> Geologist //�X / LLC.l.L<f f/C/G+l/[9CLt�y •- T <br /> / ABOVE-GROUND *7y-Box <br /> COMPLETION O <br /> SPECIAL PERMIT INFO. Ground Surf'°' <br /> Distance to sewer line grout <br /> IfDomestic well on site - (yCn 6 ft. <br /> If yes, location and distance - ft <br /> tt. - <br /> — m <br /> — o <br /> C <br /> SAMPLING slotted i = E <br /> &scion — <br /> Holding Temperature ✓� ^� _ pack <br /> gaveMethod az' <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS / n <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (yLfs/. W <br /> Storage Location �jCasing type Z Sk-k 4-O fVC_ <br /> Blank - ft. Screen 10 _ft. <br /> Slot sizeAZO <br /> GROUTING P"ABagscement 1!'±V -I 47' <br /> Buckets bentonite) ? <br /> Depth to water Bags sand/gravel .;"06 ` <br /> Mix Ratios 2-3 f 309es-Pr 50 60-4 Filter Pack type/sjz@ <br /> Installation Method .�� Surge Block: - y/ n ) <br /> Quantity Installed irw , - c 00 S'rk Discussed with geoll gist. - (y n <br /> Type of method <br /> EH 29 29 <br />