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MONITORING WELL INSTALLATION REPT <br /> —CL5 <br /> Date: I I I <br /> CONSTRUCTION <br /> J Premise Address: Total Depth /5 <br /> 1 6 r� `{— 8 1NeS2 Screen Length (from) <br /> Well No.: (to) <br /> I I Filter Pack (from)—(to) <br /> Bentonite (from) (to) <br /> Inspector: `' 2 7 q / c Grout (ft m) to <br /> �� 3 ?J I `t �3 / �� <br /> Drilling ng type p <br /> Permit No. Auger O.D. LD. I <br /> DrillingCompany: �„r a ._ I Completion - Stove pipe/ x (circle one) <br /> �'"� � j <br />- Driller: �ft u , l <br /> ,casing <br /> 9height <br /> Consultant_. ��� jmI <br /> Geologist e� W L\-t of _ <br /> A80VE-GROUND, <br /> COMPLETION CHRISTY-BOX <br /> SPECIAL PERMIT INFO. ICOMPLETION <br /> mo <br /> Ornd Sufae► <br /> Distance to sewer line grout u <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - j n• <br /> 44 n. <br /> �j <br /> SAMPLING abttad! = c <br /> ►octlon, _ <br /> Holding Temperature <br /> Method ` — gr"Bi PaC$(' <br /> Screening Method _ <br /> Tracking Sheet - (y <br /> fL <br /> SPOILS I <br /> Storage Method_ (y U�/N`�� MATERIALS/DEVELOPMENT I <br /> Contamination Noted - ( y/ f f G M <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size r �/ <br /> GROUTING Bags cement a <br /> Buckets bentonite <br /> Depth to water 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 /> c <br />