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',-,.JIONITORING WELL INSTALLATION REP( . <br /> L5Date: �� u CONSTRUCTION <br /> Premise Address: �D3 641 ' �l � '_ Total Depth <br /> r r� Screen Length (from) —(to)� <br /> Well No.: S "'"` Filter Pack (from) (to) <br /> ���'' Bentonite (from) (to} <br /> Inspector: moi"` Grout (from (to) <br /> Drilling rig <br /> Permit No. d Auger O.D. LD. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> / height <br /> Consultant <br /> T <br /> Geologist JIZ3OVE-GFtbtJNQ <br /> COMPLETION CHFi�STY-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. G=r3d Surface <br /> G.� grout <br /> Distance to sewer line <br /> Domestic well on site <br /> If yes, location and distance - <br /> — c <br /> — o <br /> SAMPLING 310ttod ` <br /> ,m� aaction <br /> Holding Temperature : pravoi Pads <br /> Method '� �� ��• <br /> Screening Method �- — <br /> Tracking Sheet - / n ) <br /> SPOILS <br /> Storage Method l_A"`k4_ MATERIAL'S/DEVELOPMENT <br /> Contamination Noted - W ) g«lpw <br /> Storage Location H^-Si Casing type _ -- <br /> Blank--.5—ft. Screen /�- ft. <br /> Slot size D � <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 n <br /> Quantity Installed�rrK Discussed with geo ogist: -7 6V n) <br /> Type of method (� <br /> EH 29 29 <br />