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'%%AONITORING WELL INSTALLATION REP <br /> Dater U 1!�f. CONSTRUCTION <br /> Premise Address: VVK (4,� Total Depth 10 <br /> Screen Length (from) 46 (to) <br /> Well No.: Filter Pack (from) I—* (to) -Z- <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) f (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 /> I �t height <br /> Consultand—'I\.,I I <br /> Geologist •� <br /> ABOVE-GROUND CHR STY43OX <br /> cOAPLETiON <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Suri <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft- <br /> 3 y ft• <br /> ft. <br /> p <br /> O <br /> SAMPLING siotwd c <br /> action <br /> Holding Tf mper re v� waviW Pack <br /> Method -� <br /> Screening Method <br /> Tracking Sheet - (y/ rf <br /> ft. b ft. <br /> SPOILS <br /> Storage Method_ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (`y ' n } <br /> Storage Location Casing WeZYpI'1c-.- <br /> Blank ft. Screen ft. <br /> Slot size LJ-07_'tO_) <br /> GROUTING Bags cement <br /> A Buckets bentonite <br /> Depth to waterAA-V f, Q-4- Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n <br /> Quantity Installed Discussed with ge ogist: - f�y! n ) <br /> Type of method <br /> EH 29 29 <br />