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_ - MONITORING WELL INSTALLATION REP <br /> r <br /> Date: � _ Ir l ' CONSTRUCTION <br /> Premise Address: F Total Depth i <br /> Screen Length (from) ; (to) 4 <br /> Well No. La.. Filter Pack ` {from)- (to) I,& <br /> - Benronite (from) (to) <br /> Inspector. Grout (from) (to) t <br /> ! Drilling rig type <br /> Permit No. .. � I'" rhj t Auger O.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: k <br /> Driller: - „ ►+ casing <br /> he; <br /> Consultant T <br /> ' <br /> Geologist � � T <br /> AWVE-GAMND Cis1SrY-80X <br /> OCKPLETCN <br /> COMPLCMON <br /> SPECIAL PERMIT INFO. C3=rdSWact <br /> i <br /> Distance to sewer line '.'- groLrt <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft- <br /> - <br /> M <br /> • ,. .. Iii � � � � y' <br /> SAMPLING sioc•.a.! — c <br /> sacicn <br /> Holding Temperature �rsvol 7-, t <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> _ M � <br /> SPOILS <br /> ;I <br /> Storage Method t i4 :i MATER.I ISZDEVEI.OPMENT <br /> Contamination Noted {y/n ) <br /> Storage Location 1-:=, i ; Casing type <br /> Blank ft. Screen Ift. <br /> Slot size <br /> GROUTING y Bags cement ,+ <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel i <br /> Mix Ratios 4 i1�,iu-!!'l a Filter Pack type/size <br /> Installation Method ;q Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist. - (y./ n)• ; <br /> Type of method } <br /> EH 29 29 <br /> "I <br /> � ti, <br />