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1 <br /> MONITORING WELL INSTALLATION REPO;A <br /> Date: /�0/D CONSTRUCTION <br /> Premise Address: �l �� LO Total Depth d <br /> Screen Length (from) SO (to) <br /> Well No.: Filter Pack (from) —(to) <br /> Bentonite (from)—(to)—I& <br /> Inspector: Grout (from)_ (to) [7 <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Compan <br /> Driller: casing <br /> height <br /> Consultant��/ —ZFW-f <br /> Geologist <br /> FN <br /> A80VE-GFiWND CNAISiY480X <br /> CO&FLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Su1xe <br /> Distance to sewer line PER, <br /> grout <br /> Domestic well on site - (y/ n ) :3(0 . tt <br /> If yes, location and distance - tt <br /> _Lft. <br /> _= m <br /> P <br /> O <br /> _ C <br /> SAMPLING slotted _ S <br /> soctlon = - <br /> Holding Temperature <br /> Method Z. QnYW Pack <br /> Screening Method r <br /> Tracking Sheet - (y/ n ) �O <br /> tt. tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) 2,, ����C <br /> Storage Location Casing type <br /> Blank 72 ft. Screen 'S <br /> Slot size oso <br /> GROUTING Bags cement <br /> Buckets bentonite 2 D <br /> Depth to water �/ Bags sand/gravel <br /> Mix Ratios ��V Filter Pack type/size 3 <br /> Installation Method Surge Block: - U n ) jok- -- (AK-k <br /> Quantity Installed Discussed with geologist: - ( yon ) <br /> Type of method <br /> EH 29 29 <br />