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i <br /> NITORING WELL INSTALLATION REPO <br /> i <br /> pppp <br /> Date: CONSTRUCTION <br /> r- I O r- <br /> ,' <br /> Premise Address:. Total Depth <br /> Screen Length (from)---7— ' (to) S5 <br /> Well No.: Filter Pack (from) (to) `;�t.� <br /> Bentonite (from) ' (to) 51 <br /> Inspector. Grout (from) -51 <br /> (to)� <br /> Drilling rig type_ .1 <br /> Permit No. c) D Auger O.D. I.D <br /> Completion - Stove pip instie c (circle one) <br /> Drilling Company: <br /> Driller. casing <br /> Theight <br /> Consultant . <br /> Geologist I1Co11E-GFiCUND <br /> OOMPLE�ION CiiFiI.STY-80X <br /> COMPLETION <br /> PECiAL PERMIT INFO. Ground Sofa" <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - g- <br /> Lft. <br /> _ a <br /> SAMPLING <br /> soden <br /> Holding Temperature ["� <br /> �raval pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) s J <br /> SPOILS <br /> Storage Method frl r MATE RIALS/DEVELOPMENT ' <br /> Contamination Noted - {y/ ) (J C_ <br /> Storage Location Casing type .9— <br /> Blank L- ft. Screen �. <br /> Slot size D 96- <br /> GROUTING Bags cement <br /> r_ Buckets bentonite / b- <br /> 1-2t-Depth to water " Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n} <br /> Discussed with geologist. - ( / n) <br /> Quantity installed - - S g Y <br /> Type of method <br /> EH 29 29 <br />