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-)NITORING WELL INSTALLATION REEPr'RT <br /> Date: \ CONSTRUCTION <br /> Premise Address: 0 S a Total Depth_ lJ <br /> , 11 Screen Length (from) I (to) <br /> Well No.: rn W Filter Pack (from) � (to) <br /> Bentonite (from) 12 (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type_, -u/ c � <br /> Permit No. Ll Auger O.D. I. <br /> ox cicle on <br /> 1 ' �� �� Completion - Stove pipe/ i bre) <br /> Drilling Company: WU i�. <br /> Driller: casing <br /> height —qw, <br /> Consultant � <br /> Geologist W_ <br /> ABOVE-GROUND <br /> COMPLETION CHRSSTY-SOX <br /> SPECIAL PERMIT INFO. Ground Surface COMPLETION <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - ( y/ n ) / O ft <br /> If yes, location and distance - ft. <br /> - m <br /> SAMPLING <br /> slotted <br /> sacton F — <br /> Holding Temperature <br /> Method �,r v7H9r pack <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> ft. <br /> SPOILS <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - Qom/ n ) i C__Storage Location Casing type V <br /> Blank 13 ft. Screen <br /> Slot size 0 Y <br /> GROUTING ( Bags cement <br /> Buckets bentonite <br /> Depth to water I 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 /> Type of method <br /> EH 29 29 <br />