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MONITORING.WELL INSTALLATION REP.(ART <br /> . _ � ;mss` f �� 5 • '` �= � � ,� - . <br /> Date: 1 l _ ,f ra ate.A CONSTRUCTION <br /> ;. . <br /> t Premise Address: /��9 ►� a�-�,. rev `' `- `1 Total Depth ��A �ti T` " `� '' ' <br /> Screen Length-(from) + (to) <br /> Well No.: C� Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: C�[y „ —�- 'i ^ . : • Grout <br /> Drilling rig type <br /> ` Permit No. Auger O.D: t ;` N I.d._- <br /> Completion - Stove pipe/christie box (circP one) <br /> Drilling Company: <br /> t Driller: casing , a ► ,,,c ' <br /> height s , <br /> ` Consultant G Com' <br /> Geologist .: U1% <br /> �r 4�_ -► ,` . <br /> ' • _''A VE-GROUND F C'"ROTY-BOX a <br /> COMPLETION <br /> i <br /> SPECIAL PERMIT INFO, G=nd Surface <br /> Qrout <br /> Distance to sewer line Ca.,wr <br /> � <br /> Domestic well on site ( y/ n ) _ ft, <br /> " If yes, location► and distance - ft. <br /> ft. <br /> a1� R q <br /> _ m <br /> C <br /> I SAMPLING o <br /> slottad — <br /> t -don — <br /> Holding Temperat►trel'C. <br /> Method <br /> Screening Method — <br /> Tracking Sheet - / n c <br /> tt.4IFft <br /> SPOILS <br /> { Storage Method Nr!� { Y-r <br /> MATERIALSZ2EVELOPMENT <br /> Contamination Noted - (y <br /> Storage Location ' Casing-type,CP'T— <br /> a"t F Blank ft. Screen ft. <br /> l � Slot size <br /> GROUTING Bags cement <br /> # <br /> Depth.to water Buckets bentonite- <br /> Bags <br /> entonite " <br /> ''�SG E Bags sand/graveI <br /> Mix Ratios_ a� Ct�vw-- ,.�( G [c5/ Filter Pack type/size --4 <br /> Installation Method t4fARI Surge Block: - (y/ n } <br /> 4 Quantity Installed eit.4au� Discussed with geologist: -.{ y/ n ) <br /> EH 29 29 Type of method <br />