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MONITORING WELL INSTALLATION REPO <br /> Date: J�- -V/8 L - -/�—�r� CONSTRUCTION <br /> Premise Address: CO Total Depth <br /> 0 Screen Length (from) L (to) <br /> Filter Pack (from) (to) <br /> Well No.: b <br /> Bentonite (from)(0(to) 6 5 <br /> Inspector: Grout (from) (5) d <br /> ;4 Drilling rigtype <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> 17�Driller: r casing <br /> height <br /> Consultant �/ <br /> Geologist ABOVE-GROUND <br /> CO&FLEfION CNRISTY BOX <br /> SPECIAL PERMIT INFO. Gourd Surlx° <br /> Distance to sewer line <br /> 456 grout <br /> Domestic well on site - ( yQ 5 h. <br /> If yes, location and distance - 69, h, <br /> = a <br /> q <br /> O <br /> C <br /> SAMPLING slotted c <br /> �����y� sarJon — - � <br /> Holding Temperature �d T 7 6 d _ gn,rdpack <br /> MethodCo i et!IX —V,� MSSS =_ <br /> Screening Method f <br /> Tracking Sheet - (D n ) <br /> SPOILS <br /> y <br /> Storage Method ^ MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n ) (/Y <br /> Storage Location t Casing type Z y/P\,c <br /> Blank ft. Screen <br /> Slot size <br /> GROUTING Bags cement �- <br /> Buckets bentonite H 0 <br /> Depth to water l5 Bags sand/gravel <br /> Mix Rados 3 t 1 Filter Pack type/size <br /> Installation Method Surge Block: - y n ) er•�oaps� <br /> Quantity Installed $ Discussed with geolo ist: - (y n <br /> Type of method <br /> EH 29 29 <br /> 30 L <br /> 10 -lP r <br /> s/ � <br />