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*1ONITORING WELL INSTALLATION REP* <br /> Date: CGK C 2 3 7olO CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to)3 <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) " <br /> Inspector: / Grout (from) (to) 1 Z <br /> Drillind IDQO�1/ Auger <br /> rig type— <br /> Permit No. Au ger O.D. I.D. <br /> 1, C_omple ' ve pipe/christie box (circle one) <br /> Drilling Company: /� � <br /> Driller: "'f 74Icase 9 <br /> eheig t <br /> Consultant <br /> 3' <br /> Geologist '/�f <br /> ABOVEGROUND CHR1SfY4= <br /> COMPLEIO COMPLETION <br /> SPECIAL PERMIT INFO. -, - _ e Ground Sum <br /> Distance to sewer line —/� ' grout <br /> Domestic well on site - n ) 3 <br /> If yes, location and distance - 2 �/� „� 3 ft. <br /> 'Zft. <br /> O <br /> m <br /> C <br /> O <br /> SAMPLING slotted = 8 <br /> taction — - <br /> Holding Temperature = gnVd Pack <br /> Method — <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) <br /> �ft. <br /> ft. <br /> SPOILS <br /> Storage Method .LlX.� 2� MATERIALS/DEVELOPMENT <br /> Contamination NAed - ( n <br /> Storage Location Casing type <br /> Blank 03V ft. Screen t S ft. <br /> Slot size .f)l <br /> GROUTING Bags cement rtSK // <br /> Buckets bentonite <br /> Depth to water 7L' Bags sand/gravel <br /> Mix Ratios — 7 f Filter Pack type/size_ 2111- <br /> Installation WtW qSurge Block: - (y(D) <br /> Quantity Installed O OG.-i Discussed with geologist: - (y <br /> Type of method <br /> EH 29 29 <br /> ��-��� A <br />