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MONITORING WELL INSTALLATION REPOAf <br /> Date: CONSTRUCTION QC <br /> Premise Address: Total Depth 6 <br /> Screen Length (from) (to) <br /> Well No.: ( Filter Pack (from) (to)_ <br /> Bentonite (from) (to) 7(� <br /> Inspector: Grout (from) —(to) O <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> 516 <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: lii'` f /➢`� *ABOVE-GROUND <br /> casi g <br /> l/heigh <br /> ConsultantZ�C <br /> Geologist CHp1S7y-BOX <br /> COMPLE71ON <br /> SPECIAL PERMIT INFO. Ground Surface <br /> ��`"�Distance to sewer line grout76 <br /> / n <br /> Domestic well on site - ( y ft. <br /> If yes, location and distance - � QU ft ft. <br /> 0 — � <br /> = m <br /> 0 <br /> = m <br /> _ c <br /> SAMPLING slotted _ c <br /> p� � sac5cn <br /> Holding Temperature ��° .CAr' o'^ _ gravel pad, <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method M 2 �(�° 4M404ftJ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y�n 20 1 <br /> Storage Location Casing type <br /> Blank ft. Screen ft- <br /> Slot size 0 <br /> GROUTING Bags cementer <br /> Buckets bentonite <br /> Depth to water ~ Bags sand/gravel <br /> Mix Ratios I` 0 rY Filter Pack type/size <br /> Installation MethA AAke�� 75'&514 Surge Block: - y/ ) <br /> Quantity Installed Discussed with geologist: (n P�C\ <br /> Type of method (s(!f( I <br /> EH 29 29 <br />