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! r <br /> MONITORING WELL INSTALLATION REP�rc� <br /> r <br /> Date: `� 22 p�- �► :5-Z-3 -b-7 CONSTRUCTION <br /> Premise Address: Co CLO Total Depth <br /> / Screen Length (from) (to) <br /> Well No.: — �g ( BZdue� Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> �S � <br /> Driller: `fE55E -t <br /> casing <br /> height <br /> Consultant Li /4-'�t;�.+,s rF"� <br /> Geologist U Ct44, <br /> ... ' <br /> ABOVE-GROUND CNAtSIY48GX <br /> 'E COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Around Sw1w* <br /> Distance to sewer line L So grout <br /> 4!f!p! LlIT <br /> Domestic well on site - (y <br /> If yes, location and distance- ft• <br /> fL <br /> n. is <br /> i &: q •i <br /> SAMPLING •bid ;; c <br /> iaCSIOn r` <br /> Holding Temperature <br /> Method gmvd pack <br /> <«. {, <br /> Screening Method 1 D <br /> Tracking Sheet - n) <br /> fL IF IF <br /> MV <br /> Storage Method ��N'( MATERIALS/DEVELOPMENT <br /> Contamination Noted (y <br /> Stmage Location 1� 5-1 1 '#y �h y C.+gi44 type l <br /> Blankft-7 'Screen h <br /> Stot size <br /> SROU" tNG ,1 ; Bags cement T <br /> Buckets bentonite - <br /> to,water = (rJ Bags sand/gravel O� i <br /> Mix Ratios Filter Pack type/size -3 { <br /> Installation M"d Surge Block: - (y/n) <br /> Quantity infed s Discussed with geologist: - (y/n) <br /> El;#�29 2�9� _ <br /> Type of method <br />