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)NITORING WELL INSTALLATION REPr"P- <br /> Date: 13 CONSTRUCTION <br /> Premise Address: D Total Depth / 4 <br /> },� \ Screen Length (from) 1 d (to) OfD <br /> Well No.: / 1 LU Filter Pack (from) i Y 0 (to) /,,15 <br /> �- Bentonite (from) Ia-S (to) /-20 <br /> Inspector: ( Grout (from) (to) c 7 <br /> �7 Drilling rig type ct.4 <br /> Permit No. Auger O.D. 7, <br /> Completion - Stove pi tie bo )(circle one) <br /> Drilling Company: j-AJ N(�AA11-If A' <br /> Driller: tA/Y�aj"WA casing <br /> height <br /> 1 '7 T <br /> —WWT <br /> Consultant J � C� <br /> Geologist ; y \ V,-Ak -- <br /> ABOVE-GROUND <br /> COMPLETION C>•tRSSTY$OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. G=nd Surface <br /> Distance to sewer linegrout <br /> Domestic well on site - ( y/ n ) 1 j2G ft <br /> If yes, location and distance - <br /> r <br /> o <br /> o <br /> SAMPLING slotted <br /> soc5on <br /> Holding Temperature = <br /> Method „ _ P <br /> ack <br /> �: <br /> Screening Method _ <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y <br /> Storage Location Casing type V <br /> Blank 4_� O ft. Screen <br /> Slot size t L <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 L <br /> Lk k 1; CL��le5 <br />