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MONITORING WELL INSTALLATION REPOT f <br /> Date: 0� CONSTRUCTION <br /> Premise Address: 6ao Total Depth 25 ' <br /> T Screen Length (from) CD (to) 2;5 <br /> Well No.: --1— L Filter Pack (from) (to) 2-5, — <br /> Bentonite (from) (to) l _ <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. ( Auger O.D. g I.D. <br /> Completion - Stove pipe/christie box (c' cle one) <br /> Drilling Company: <br /> Driller: / / casing <br /> height <br /> Consultant <br /> TFF <br /> Geologist •- 7F <br /> AE&E-GROUND ( CHRLM43OX0OWFLETION <br /> compt-Enc <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line Grout <br /> Domestic well on site - (y G) �- <br /> If yes, location and distance - $N ` <br /> — <br /> r E 7�1 1 <br /> �� <br /> , _ r <br /> c <br /> • SAMPLING ` I AA slotted <br /> �o •{I _�'Nw� aatton —_ <br /> Holding TemperatureVIVW <br /> Method _ P <br /> ack <br /> Screening Method = <br /> Tracking Sheet - n ) <br /> SPOILS <br /> Storage Method 55 5�r MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y <br /> Storage Location Casing type r <br /> Blank ft. Screen ft• <br /> Slot size OW <br /> GROUTING r Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel�� <br /> Mix Ratios Filter Pack type/size <br /> Installation Method 2 r23 Surge Block: - (y n <br /> Quantity Installed Discussed with geo ogist: - (y� <br /> Type of method �— <br /> EH 29 29 <br />