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MONITORING WELL INSTALLATION REPb1(T <br /> Date: UV CONSTRUCTION <br /> Premise Address: ZG+ f Total Depth <br /> Screen Length (from) (to) <br /> Well No.: G`'�"7 J& Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. _ 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 c,C . - _ . 41 1 T_ _QVT <br /> Geologist --• <br /> ABOVE-GACUND CHR;t480X <br /> COIFLETiON COMPLETION <br /> SPECIAL PERMIT INFO. Gra=nd Sirlacs <br /> Distance to sewer line preut <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - tI- <br /> ft. <br /> K. <br /> �,• — M <br /> 0 <br /> SAMPLING slorv.•i � <br /> sar7cn ��� <br /> Holding Tep perature <br /> Method 11 vfN ' ` — R"`W Pack <br /> Screenin;Method N — <br /> Tracking Sheet - ( n ) ; <br /> A ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> BIank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water-31g-361 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 />