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\ 1 <br /> ~MONITORING WELL INSTALLATION REPOrt <br /> Date:_ 3�Z ( / F� CONSTRUCTION <br /> Premise Address: 1(vS296) Total Depth <br /> �/ a� Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> � <br /> Bentonite (from) to) <br /> Inspector: Grow- Q tom <br /> �� 50©O� Drilling rig type (%jLGF <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: �� f casing <br /> height <br /> Consultant4 7T <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION CHRZTY-8OX <br /> COMPLET7CN <br /> SPECIAL PERMIT INFO. // Ground Surfaca <br /> Distance to sewer line (O� I grout <br /> Domestic well on site - ( y 3 n. <br /> If yes, location and distance - �!!r� ss 1t. a 11 <br /> SAMPLING ClotIted = st <br /> = 'c <br /> saction <br /> Holding Temperaturegmy1w <br /> PaCK <br /> Method = <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) _ <br /> n. n. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted y Cn .� nv <br /> Storage Location Casing type r <br /> Blank ft. Screen (5 ft. <br /> Slot size . ('yrD <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 12, 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 /> 3 Z3 �- l� �' �< p� ..� "PIC la Y <br />