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MONITORING WELL INSTALLATION REP <br /> i" <br /> Date: CONSTRUCTION <br /> Premise Address: ZbJ5 C6 — Total Depth <br /> Screen Length (from) I (to) <br /> Well No.: Filter Pack (from) lQ7(to) L <br /> Bentonite (from) 2 (to) <br /> Inspector: Grout (from) l (to) O <br /> Drilling rig type <br /> Peru � <br /> No. d ITT Auger O.D. I.D._ <br /> Completion -Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: r casing <br /> height <br /> i <br /> Consultant <br /> Geologist L��� 17T <br /> ABOVE-GROUND <br /> COMPLETION c.Haisnr-sox <br /> SPECIAL PERMIT INFO. Ground ace <br /> t ' <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) l <br /> ' it. <br /> �p If yes, location and distance - qq Z <br /> t ^� <br /> a¢ p <br /> { SAMPLING sbttad <br /> s*don <br /> N <br /> Holding Temperature packMethod ._ <br /> Screening Method <br /> Tracking Sheet (y/n) _- <br /> spons <br /> Storage Method J MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n ) 2n sa <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size • <br /> GROUTING Bags a <br /> Buckets bentonite <br /> Depth to water Z"' Bags sand/gravel <br /> Mix Ratios Filter Pack typesize <br /> Installation Method Surge Block: - (y ri <br /> Quantity Installed Discussed with geologists= (y n) <br /> Type of method <br /> EH 29 29 <br /> 67 e' L /Com' <br />