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q <br /> MONITORING WELL INSTALLATION REPOici <br /> Date: Zd �v / � CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Z � Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> �lS�2 Drilling rig type <br /> Permit No. f Auger O.D. LD. <br /> f Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: fTLPJ{ <br /> Driller: d casing <br /> height <br /> i Consultant <br /> ° <br /> Geologist aaw= <br /> ABOVEGROUND <br /> COMPLETION _COMPLT <br /> COMPLETION <br /> SPECIAL PERMIT INFO. ( ( � .q • Ground Surface <br /> Distance to sewer line � U grout <br /> Domestic well on site - ( n ) <br /> If yes, location and distanc - � ft' <br /> 2,T ft <br /> 'fib ft <br /> Vm <br /> SAMPLING slatted = l' <br /> 40 taction <br /> Holding TempegnVig rature = f <br /> ack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - ( y / n ) <br /> JO ft. - ft. <br /> SPOILS <br /> ii Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y�D <br /> Storage Location Casing type <br /> Blank n) o ft. Screen 1V ft. <br /> Slot size 020 " <br /> GROUTING Bags cement o CtFY <br /> Buckets bentonite <br /> Depth to water 3 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 3 <br /> Installation Method Surge Block: - ( y / n ) <br /> Quantity Installed Discussed with geologist: - ( y / n ) <br /> Type of method <br /> EH 29 29 <br />