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MONITORING WELL INSTALLATION REPr-',?T <br /> Date: Q CONSTRUCTION/ <br /> Premise Address: /`�� Total Depth 6 0 <br /> Screen Length (from) (0 (to) v <br /> Well No.: l/ Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: �1� � Grout (fro;n) (to)$moi. <br /> Drilling rig type Li <br /> Permit No. Au e I.D. % <br /> Completion - St ve`pipe/christie box (circle one) <br /> Drilling Company:�Q� <br /> Driller: casi� <br /> height,Consultant � <br /> Geologist <br /> \ IIBOHMPLETILETT ABOVE-GROUND CHRSSTY-80X <br /> COON <br /> SPECIAL PERMIT INFO. Ground Surfxf COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) i <br /> If yes, location and distance - ft. <br /> qn ft. ft. <br /> = m <br /> = m <br /> SAMPLING <br /> slottQd � <br /> wcjon — <br /> Holding Temperature <br /> Method = gr"�pack <br /> Screening Method <br /> Tracking Sheet - (y/ n ) _ <br /> SPOILS Cn 0 <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Cont Location <br /> Contamination Noted - (y/ n <br /> Storage ) Casing e �' PUG SCL�0 <br /> Blank 0 ft. Screen 2 0 ft. <br /> Slot size 10 <br /> GROUTING Bags cement <br /> '15-0 Buckets bentonite -7S <br /> Depth to water Bags sand/gravel `) <br /> Mix Ratios Filter Pack type/ ' e 3 <br /> Installation Method Surge Block: - ( n ) <br /> Quantity Installed Discussed with geologist: - d/ n ) <br /> Type of method <br /> EH 29 29 <br />