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MONITORING WELL INSTALLATION REPOT I <br /> Date: CONSTRUCTION <br /> Premise Address: �� J / Total Depth 61D <br /> Screen Length (from) S� (to) D <br /> Well No.: Filter Pack (from) 5el (to)_ <br /> Bentonite (from)--V—(to) 305 <br /> Inspector: Grout (from) 3 C� (to) <br /> c� Drilling rig type E <br /> Permit No. , J�r7 s� Auger O.D. Q' I.D. <br /> It <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: f Z casing <br /> height <br /> Consultant �� <br /> Geologist <br /> ABOVE-GROUND �.�,� <br /> COMPLETION COMP <br /> SPECIAL PERMIT INFO. Ground Su 1we <br /> Distance to sewer line C50 grout <br /> Domestic well on site - (y <br /> If yes, location and distance - n, <br /> �n. <br /> m <br /> Q <br /> SAMPLING slot _ c <br /> sacdon <br /> Holding Temperature N b _ rq Pack <br /> Method <br /> Screening Method t.` _ •` <br /> Tracking Sheet - (y/ n ) d <br /> SPOILS <br /> Storage Method r'/lf �l" MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ 211 n <br /> Storage Location Casing type O- <br /> Blank 40ft. Scr n I <br /> Slot size I 1.02-Ot' <br /> GROUTING Bags cement <br /> Buckets bento 'te I Z <br /> Depth to water l� Bags sand/gravel 400' <br /> Mix Ratios Ot // Filter Pack type/size 3 <br /> Installation Methed w t ZC/ Surge Block: - (a�j n ) <br /> Quantity Installed -f6-jtA Discussed with geologist: - ©n ) <br /> Type of method <br /> EH 29 29 <br /> ����7 <br />