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MONITORING WELL INSTALLATION REPaT <br /> Date_.4,Lq l'7 1 _ CONSTRUCTION <br /> Premise Address: ro �. ' AHZIG-' Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stave pipe/christie box (circle one) <br /> Drilling Company- <br /> Driller: casing <br /> n � height <br /> Consultant �,�;;c;;1�- �..-�C � 'b <br /> Geologist -- <br /> AWVE-GRCt,N0 GiA1STY-BOX <br /> CC WLETIC N COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface .-..—.-.+, <br /> Distance to sewer line <br /> NI grout <br /> Domestic well on site - y n ) �,�--mit. <br /> If yes, location and dist ce - ft. <br /> M <br /> SAMPLING slo6d — C <br /> Yr <br /> 6 aecicn s _ <br /> Holding Temperature L <br /> Method RaY�1 <br /> ack <br /> :4 <br /> Yi• - <br /> Screening Method WA ^`0 oltcs <br /> Tracking Sheet - /n ) <br /> r a._...r...ft. ...--.... ""� tt. <br /> SPOILS N f <br /> Storage Method MATER.I ZSMEVEI.OPMENT /V//$ <br /> Contamination Noted - (y/ 7 <br /> Storage Location Casing type <br /> BIank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> ' - Buckets bentonite <br /> Depth to water 3 S i /'^ �."�t _ 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 />