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tatONITORING WELL INSTALLATION REPO. ,1 <br /> Date:`/ �� CONSTRUCTION <br /> Premise Address: ��L7 u Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) ;'0 (toTT: <br /> l�� Bentonite (from) (to) Y <br /> Inspector: -"e'P Grout (from) 7-- (to) <br /> � <br /> Drilling rig type r" `I <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist •- <br /> FF <br /> ABOVE-GROUND CHRLM43OX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. / Ground Surface <br /> Distance to sewer line Gproof <br /> Domestic well on site - (y n ) ft. <br /> If yes, location and distance - <br /> ft. ft. <br /> SAMPLING <br /> slotted _ c <br /> seclon <br /> Holding Tempgrature Z <br /> Method <br /> Screening Method <br /> a: <br /> Tracking Sheet -I(W n) <br /> ft. ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - <br /> Storage Location- w�YC/k-�t Casing type 2,y Pvt/ <br /> Blank ft. Screen <br /> Slot size O,OZA <br /> GROUTING Bags cement <br /> / Buckets bentonite <br /> Depth to water e? Bags sand/gravel _ <br /> Mix Ratios Filter Pack type/;*ze 3 <br /> Installation Method Surge Block.. - / n ) <br /> Quantity Installed Discussed with geologist: - fl/ n) <br /> Type of method <br /> EH 29 29 <br />