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� fr <br /> MONITORING WELL INSTALLATION REPOnf <br /> / iso <br /> Date: I CONSTRUCTION <br /> Premise Address : Total Depth �✓ <br /> Screen Length (from) 30 (to) Sa <br /> Well No. : �� Filter Pack (from) 2 ) Sd <br /> Bentonite (from) 28' (to) Z5 <br /> Inspector: Grout (from) 2:�c (to) 0 <br /> Drilling rig type g I <br /> Permit No. ego o�i Auger O.D. I.D. <br /> D Completion - Stove pipe/christie box (circle one) <br /> Drilling Comp/an �QQ�� <br /> Driller: t! / l017 ( casing <br /> pp C height <br /> Consultant U/C. � <br /> GeologistDPLETION ABOVE- <br /> GROUND <br /> COI �LEiION <br /> SPECIAL PERMIT INFO. Ormond Swhce <br /> Distance to sewer line ? grout <br /> Domestic well on site - ( y 25 <br /> If yes, location and distance - P n' <br /> fin. n. <br /> SAMPLINGI = '7. <br /> �e slo tod = E <br /> 0 C wc4an = <br /> Holding Tempera e <br /> Method — V" pack <br /> Screening Method <br /> Tracking Sheet -On ) <br /> 5U nI F = n. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) o <br /> et <br /> Storage Location Casing type <br /> Blank 3 ft. Screen ft. <br /> Slot size -O <br /> GROUTING Bags cement <br /> Buckets bentonite kdCt ; <br /> Depth to water / j 7 y Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method t< ' / '^/y Surge Block: - ( y n ,�'�� <br /> Quantity Installed Iz Discussed with geo ogist: -1 y n ) <br /> Type of method NOdoka <br /> EH 29 29 <br />