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• r <br /> 40NITORING WELL INSTALLATION REPT <br /> Date: /. , }_ CONSTRUCTION , <br /> f cc D U' <br /> Premise Address:1530C �36) �J C _ )b. ` w ',Total.D�epth ' • t° <br /> Screen Length (from) <br /> Well No.: 1 ' � tOl�) ®r 11 (to)Filter Pack (from) (to) <br /> j' Bentonite (from) (to) <br /> Inspector !/�,n�-Q� . - �t Grout, (from) (to) ` <br /> E •Drilling rig type <br /> Permit No. ,�+ t ^\ Auger O.D. I.D. <br /> < i Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> ` - height <br /> Consultant Z A.& <br /> Geologist t <br /> ABOVE-GROUND <br /> COWPLETION CNA15T1'8aX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Su lace <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance- <br /> O <br /> 4, m <br /> SAMPLING slotted <br /> socdon "— <br /> Holding Temperature _ P <br /> Method — <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> .:>: r• }. +- J <br /> 7 S �'Y <br /> y <br /> SPOILS <br /> a <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location - Casing type <br />-� Blank ft. Screen ft. <br /> Slot size <br /> t GROUPING Bags cement <br /> Buckets bentonite <br /> 1' 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 />