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ZONITORING WELL INSTALLATION REP. .t <br /> Date: f/� CONSTRUCTION <br /> Premise Address:-3S764 ��� Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: LA Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant �TL[ <br /> Geologist 97h <br /> ABOVE-GROUND <br /> CO tuff'LETIO N CHR51Y-BOX <br /> COMPLI_TICN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line Grp <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - n <br /> ft. <br /> ft. <br /> = o <br /> q <br /> 0 <br /> C <br /> SAMPLING = g <br /> slotted — C <br /> sec�on — <br /> Holding Temperature —_ <br /> Method — gs"w Pack <br /> Screening Method =_ <br /> Tracking Sheet - ( y/ n ) <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <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 Discussed with geologist: ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />