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,_.,)NITORING WELL INSTALLATION REPOli--, <br /> Date: S/l D11Z CONSTRUCTION <br /> Premise Address: Total Depth_ <br /> 3 <br /> Well Np/'4re/ � C�„� –3 Screen Length (from) (to) <br /> o.: _ Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: 16.VVA Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe,/christie box (circle one) <br /> ��� <br /> Driller: <br /> // casing <br /> Consultant <br /> ATV height <br /> Geologist <br /> ABO VE-G R CUN D <br /> CO 1.1 LET{O N C4iRSTY-BOX <br /> SPECIAL PERMIT INFO. COMPLETION <br /> Ground Sur-Ixa —. <br /> Distance to sewer- line grout <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance <br /> y ft. <br /> m <br /> S <br /> SAMPLING Sot ��� _ n• <br /> •lo"ad _ <br /> Holding 'Temperature_ — <br /> Method �l��+vy.`q� etr.�y -• �nvet pacts <br /> Screening Method — <br /> Tracking Sheet - n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type NlA <br /> Blank ft. Screen�fr. <br /> Slot size N V _ _ <br /> GROUTING Bags cement <br /> j� Buckets bentonite ! S <br /> Depth to water d 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 /> EH 29 29 Type of method <br />