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MONITORING WELL INSTALLATION REP�y <br /> ? <br /> Date: Z l b 7 <br /> j CONSTRUCTION <br /> Premise Address: � s Total Depth <br /> �/� Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Inspector: Bentonite (from) Z (to) , <br /> P Grout (from) (to) O <br /> Drilling rig type z c. <br /> Permit No. 4-;7W Auger O.D. rft I.D. 4 <br /> Drilling Company: Completion-Stove pipe/christie boa (circle one) <br /> Driller:_ lye - 7- T 't)2�� casing . <br /> height <br /> Consultant GeologistABOVEGROUNDii <br /> COMPLETIONSPECIAL PERMIT INFO. pend Wfw <br /> Distance to sewer line �- V grout <br /> Domestic well on site - ( n b �• <br /> If yes, location and distance - -� <br /> S NG <br /> abetad = c <br /> aacdon <br /> Holding Tempera C. N = <br /> Method =_ pack <br /> Screening MethodZAP <br /> Tracking Sheet (y n) ` _ <br /> tL <br /> SPOILS S� <br /> Storage Method ��/� MATERIALS EVELOPME <br /> Contamination Noted - (y/n) yr 'P ir/� <br /> Storage LocationQ�3'1�cC Casing type 1 l.. <br /> Blank ft. Screen - ft. <br /> Slot size .0.20" <br /> GROUTING Bags cement S f L <br /> Buckets bentonite 'j0 <br /> Depth to water � �S Bags sand/gravel <br /> ildiu Ratios Filter Pack typesize <br /> Installatibn eth Surge Block: - (y <br /> Qu$ntity Installed !& t�� Discussed with geologist: - (y no <br /> Type of method <br /> EH 29 29 <br />