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ONITORING WELL INSTALLATION REPO <br /> Date: I t� - ( CONSTRUCTION <br /> Premise Address: Total Depth ' <br /> �1 Screen Length (from) (to) 24,15 . <br /> Well No.: Filter Pack (from) (to) `Z-013 <br /> Bentonite (from) ? - (to <br /> )� <br /> Inspector. �J�J Grout (from) (to) ice_ <br /> �V Drilling rig type i <br /> Permit No. v, ( � �� Auger O.D. �2 7 <br /> g Company:. n �� Completion - love p' c ristie box (circle one) <br /> Drillin Com/Jan : 1(/i // f r� <br /> Driller: �VJG1NS+1^ F16 casing 1�� <br /> pp /; � height ConsultantjO lR F 1 f Ul(�/8 (f -� <br /> Geologist�� [�Fm QA � A80VE-GROUND <br /> T <br /> t0MPLETCN CHR*IY-BOX <br /> C.CMPLEnCN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - y/ n ) <br /> If yes, location and distance vfftt. <br /> Y' 0 <br /> p <br /> C <br /> SAMPLING slotted <br /> saricn — <br /> Holding Temperature /lJ� <br /> Method = P <br /> ack <br /> Screening Method ^r^ <br /> Tracking Sheet - ( y/ n ) <br /> ft. = ft. <br /> SPOILS <br /> i <br /> Storage Method X-Vi MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) � I <br /> Storage Location Casing type <br /> Blank a f> ft. Screen � ' ft. <br /> Slot size 01 D <br /> GROUTING Bags cement <br /> Buckets bentonite'Depth to water Bags sand/gravel ��z <br /> Mix Ratios Filter Pack type/size <br /> Installation Method PJ^n„ Q Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />