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vMONITORING WELL INSTALLATION REPORT <br /> Date: 3 I I a -7 CONSTRUCTION <br /> Premise Address: Total Depth 151 <br /> Screen Length (from) 5-- <br /> Well <br /> Well No.: Filter Pack (from) 3 (to) /3 <br /> Bentonite (from) '.�C (to) 3 <br /> Inspector: Grout (from) w F c c- (to) 2 <br /> Drilling rig type <br /> Permit No. ( Y3 Auger O.D. I.D. <br /> rCompletion- Stove pipe/christie box (circle one) <br /> Drilling Company: ) �� ����!� <br /> Driller: casing <br /> height <br /> Consultant �� � <br /> Geologist —ZrT <br /> ABOVE-GROUND CtiAf5N 80X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground SuAxw <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - <br /> .�ft. tt <br /> SAMPLING slotted <br /> sac9on <br /> Holding Temperature <' <br /> Method _ gmvlw Pack <br /> Screening Method <br /> Tracking Sheet - (y/n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) ft ✓C <br /> Storage Location Casing type <br /> Blank S ft. Screen <br /> Slot size <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: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />