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MONITORING WELL INSTALLATION RE��T <br /> Date: /i5 Z-7 D CONSTRUCTION <br /> Premise Address: ia' 2--5 ��[ Total Depth_6j''C?-6 <br /> Screen Length (from) (to) <br /> Well No.: /4 ill Filter Pack (from) (to)- <br /> Inspector Bentonite (from) (to) <br /> Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion -Stove pipe/christie box (circle one) <br /> Driller: oaa inq <br /> height <br /> Consultant 7T <br /> JeE <br /> GZ9V A <br /> ABOVE-GACCND CHAfSTY-80X <br /> G�OMPLI:f10N COMPLEnON <br /> SPECIAL PERMIT INFO. Gmund Sufaca <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - ft. 7F <br /> �a » <br /> �1 — <br /> SAMPLING ` = s <br /> slorod a: <br /> sac�cn "" <br /> Holding Temperature r <br /> Method ~' _ Vi/°I Pack <br /> Screening Method xv <br /> Tracking Sheet - {y/ n } <br /> _ <br /> w <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/171) <br /> Quantity Installed Discussed with geologist: - (y <br /> EH 29 29 Type of method <br />