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,,,�IONITORING WELL INSTALLATION REPS <br /> Date: CONSTRUCTION <br /> Premise Address: f`Od�✓ L, Total Depth <br /> 7 Screen Length (from) (to) <br /> Well No.: G �� �"�''�`r/j Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. l/' I.D. Z <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:�� <br /> Driller: casing <br /> Irm Theight <br /> Consultant �� T <br /> Geologist 7,5, T <br /> A$OVE-GROUND C4RISTY-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surf=* <br /> Distance to sewer line �I(Xi grout <br /> Domestic well on site - (y/n ) 1 <br /> If yes, location and distance - � <br /> a;� r <br /> O <br /> SAMPLING BIG* <br /> saodonpack <br /> •• — <br /> Holding Temperature <br /> Method —_ <br /> Screening Method ; <br /> Tracking Sheet - y n ) <br /> it. fL <br /> SPOILS <br /> Storage Method 'ela"A� MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n ) <br /> Storage Location sy Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROLMNG Bags cement <br /> Buckets bentonite <br /> Depth to water 2-0 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method 24 Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n } <br /> Type of method <br /> EH 29 29 <br /> z S <br />