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0ONITORING WELL INSTALLATION REPO <br /> Date:_T - �L CONSTRUCTION <br /> Premise Address: 1 f S' 41 Total Depth <br /> Screen Length (from) (to) <br /> < Filter Pack (from) (to) <br /> Well No.: !pJ <br /> Ji Bentonite (from) (to) <br /> Inspector: ^D \ Grout (from) (to) <br /> Drilling rig type <br /> Permit No. <br /> x'200 3 Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: CL'�"t'Q o casing <br /> height <br /> Consultan <br /> 717 <br /> Geologist Agpyg-GROUND <br /> COMPLI710N CNRISTY-80X <br /> COMPLEnON <br /> SPECIAL PERMIT INFO. Ground Surf act <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> = b <br /> — o <br /> SAMPLING slotad = c <br /> aacdon <br /> Holding Temperature = gmve Pads <br /> Method <br /> Screening Method ' — <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) <br /> Storage Location Casing typeL <br /> Blank ft. Screen ft• <br /> Slot size 0,00 <br /> GROUTING Bags cement <br /> t Buckets bentonite <br /> Depth to water 11b Bags sand/gravel <br /> Mix Ratios '�X 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 />