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&NITORING WELL INSTALLATION REPOke <br /> — my <br /> ]y /1 9 1 <br /> Date: 03�e `03 CONSTRUCTION <br /> Premise Address: ( �� �� �' Total Depth <br /> Screen Length (from) (to) '� z <br /> Well No.: & Filter Pack (from) 3 7-f (to) 30 <br /> Bentonite (from) 3w (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type W dd T UB <br /> Permit No. Auger O.D. 91, I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: 1/ �/N <br /> Driller: �/tV( ��f�h casing <br /> height <br /> Consultant <br /> Geologist 7fr �Ltt ABOVEGROUND <br /> COMPLETION CON <br /> COMPLETION <br /> SPECIAL PERMIT INFO. �� Surfxa + �_ <br /> Ori <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) n. <br /> If yes, location and distance - n. <br /> _.n. <br /> m <br /> SAMPLING ft�P�G3 C��eclCvf slonad _ 8 <br /> sacion <br /> Holding Temperature 8I P <br /> Method = <br /> Screening Method <br /> Tracking Sheet - (y/n ) : <br /> tt. = tt. <br /> SPOILS <br /> Storage Method lQ <br /> �/� MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) <br /> Casing type <br /> Storage Location <br /> Blank ,I- 32-s fr. Screen 2-r fr. <br /> Slot size <br /> GROUTING <br /> Bags cementa �„Q1 (fie T/1r ff et <br /> Buckets bentonite <br /> �y/ Bags sand/gravel <br /> Depth to water <br /> Filter Pack type/size <br /> Mix Ratios <br /> �w / n wlt � Surge Block: - (y/ n) <br /> Installation Method P — Discussed with geologist: - (y/ n) <br /> Quantity Installed 3a NePO�.S Type of method <br /> EH 29 29 <br /> `vim aauv�n f�� <br />