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IqONITORING WELL INSTALLATION REPO <br /> CONSTRUCTION ,t <br /> Premise Address: 6� Total Depth <br /> Screen Length (from) 13 (to) <br /> Well No.: / �/ Filter Pack (from) (to)(— <br /> Bentonite (from) (to) 31— <br /> Inspector: Grout (from) (to) <br /> Drilling rig type PF <br /> Permit No. Auger O.D. K I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: ? // �/ kLET <br /> g <br /> t <br /> Consultant <br /> Geologist �.,,i\ i��/2LGl�K T <br /> CHRJSTY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. (/ Ground SuAxa <br /> Distance to sewer line <br /> �(�'�� — �(,u,Ur•�{ grout <br /> Domestic well on site -0 n <br /> If yes, location and distance - ft• <br /> ft• r _ — m <br /> It <br /> SAMPLING slot <br /> taction — - � <br /> Holding Temperature = P <br /> ack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - (y/ n ) S3 = 3 <br /> SPOILS (per <br /> Storage Method , -11 "O MATERIALS/DEVELOPMENT <br /> Contamination Noted7- (y n 2i. <br /> Storage Location Casing type <br /> Blank 3T- ft. Screen <br /> Slot size 'Ot <br /> GROUTING Bags cement !o Z Q f <br /> t Buckets bentonite 1 <br /> Depth to water Z Bags sand/gravel Od' <br /> Mix Ratic 7 SOA ZI f Filter Pack type/size L <br /> Installation Method Surge Block: - (y n ) ,�-�, <br /> Quantity Installed — Discussed with geologist: - (y A0 <br /> Type of method <br /> EH 29 29 <br />