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r •NITORING WELL INSTALLATION REPO',* <br /> CONSTRUCTION <br /> Date: � { <br /> 40" �uu �e.ry .� Total Depth 37- <br /> Premise Address: �( Screen Length (from) 3?- (to) <br /> Wel] No.: /' Filter Pack (from) 3U (to) <br /> Bentonite (from) Zs (to) L- t 30 <br /> NC Grout Cfrom) a i' t•' (to) S t zW <br /> Inspector: Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Y Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: V w <br /> F casing <br /> Driller: �1K b'r ' """ height <br /> Consultant <br /> Geologist e ABOVE-GROUND <br /> CNRIST'Y-BOX <br /> COMPLETION COMPLETION <br /> Ground Surface <br /> SPECIAL PERMIT INFO. <br /> - �. <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - ft' <br /> ft. <br /> O <br /> C <br /> •� O <br /> slotted <br /> SAMPLING sac an <br /> Holding Temperature <br /> Method <br /> Screening Method ` —_ <br /> Tracking Sheet - (y/n) <br /> = 1tL <br /> SPOILS <br /> Storage MethodMATERIALS/DEVELOPMENT 7�y <br /> 3� r� �� C <br /> Contamination Noted - (y/ n) Casingge <br /> Storage Location Blank + Z.s' Screen 2.9 ft• <br /> Slot size Z <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> s 70 14e l� Filter Pack type/size <br /> Mix Ratio <br /> Surge Block: - (yon) <br /> Installation Method Discussed with geologist: - (y/ n <br /> Quantity Installed ) <br /> Type of method <br /> EH 29 29 <br /> W <br />