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MONITORING WELL INSTALLATION REPOici <br /> i <br /> Date: 1� CONSTRUCTION <br /> Premise Address: 0� Total Depth 50 <br /> Screen Length (from) '5'0 (to) S � <br /> Well No. : Filter Pack (from) `So (to) ? — <br /> Bentonite (from) (to) Z5— <br /> Inspector: Grout (from) 2S (to) C� <br /> Drilling rig type <br /> Permit No. Auger O.D. 19' I .D. 4- <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: (�'[.�� <br /> Driller: casing <br /> \ height (te <br /> Consultant Geologist i ` > Lc <br /> BOVE-GROUND <br /> COA�LEfION <br /> SPECIAL PERMIT INFO. x� ry ` Ground Surtxs <br /> �() ' Yom.. grout <br /> Distance to sewer line 3 <br /> Domestic well on site - ( y / n <br /> If yes, location and distanc l <br /> ft. <br /> 3o rt. <br /> SAMPLING I — 'Z_ E <br /> slotted — $ <br /> � b tactlan <br /> Holding Temperature = P <br /> ack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - ( y / n ) t, <br /> 50 ft = ft <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( r n 2a /I ,T(AUL <br /> Storage Location Casing type CKo `�0 <br /> Blank '50 ft, Screen 2oO ft, <br /> Slot size 024, <br /> GROUTING Bags cement W1 <br /> Buckets bentonite l <br /> Depth to water Bags sand/gravel D <br /> Mix Ratios + Filter Pack type/size <br /> Installation Method wt Surge Block: - ( y / n ) <br /> Quantity Installed Discussed with geologist: - ( y / n ) <br /> Type of method <br /> EH 29 29 <br /> /011 /© q, <br />