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MONITORING WELL INSTALLATION REPO <br /> Date: �U / U S CONSTRUCTION <br /> Premise Address: !�?� S Total Depth <br /> / Screen Length (from) (to) <br /> Well No.: 6�04 10Aur4 Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: ii '`�/ Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - St a pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: U'y casing <br /> height <br /> Consultant <br /> Geologis <br /> /II-- T OVE-GROUND CHR*'rY-SOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface T <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - <br /> ft. ft. <br /> SAMPLING s1o6d <br /> aacdon <br /> Holding TemperatureV&VWpawk <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n) <br /> Storage Location Casing type Az <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> i Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />