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WONITORING WELL INSTALLATION REP <br /> Date: a a 9 o"/ /n CONSTRUCTION <br /> Premise Address: `""' Total Depth <br /> �j Screen Length (from) O (to) d <br /> Well No.: r/ Filter Pack (from) (to) <br /> Bentonite (from) ZfK (to) <br /> Inspector: Grout (from) (to) ++— <br /> �- Drilling rig type_ <br /> Permit No. C�/ Z 1p0 z Auger C.D. <br /> �t I.D. !o <br /> Completion- stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: �Q'0� r tABtOVE-GROUND <br /> ing <br /> ght <br /> Consultant <br /> Geologist"`^" ry –"` CNAI5TY BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. ' <br /> grout <br /> Distance to sewer line 43 <br /> Domestic well on site - (y nn t N ft <br /> If yes, location and distance .�O ft. <br /> r = <br /> a <br /> SAMPLING .loved = ` <br /> sec�on = <br /> Holding Temperature = g"w� <br /> Method = =-- <br /> Screening Method ' — <br /> Tracking Sheet - (y/ n ) �0 <br /> ft. Lft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) t 6 <br /> Storage Location Casing type � ` <br /> Blank fr. Screen h• <br /> Slot size �0 <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: - ( / n <br /> Quantity Installed Discussed with ge gist: - ( y� <br /> Type of method <br /> EH 29 29 <br />