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MONITORING WELL INSTALLATION REPOr�.f <br /> Date: A* [ �!��� CONSTRUCTION <br /> Premise Address: ` Total Depth <br /> Screen Length (from) Y5 (to) 2. <br /> Well No.: Filter Pack (from) (to)'ZJ5 <br /> Bentonite (from) 2 (to) L( <br /> Inspector: Grout (from) 21 (to) O <br /> ! Z Drilling rig type x, 2_5 40f. <br /> Permit No. (� Auger O.D. S_ I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: b2 casing <br /> Consultant v h``J <br /> j,�0 c— Y)--- � height <br /> Geologist 7//, <br /> ABCVF--GRC(JND <br /> t5TY80 <br /> X <br /> COML_MCCOWLErbN cSPECIAL PERMIT INFO. Grond Suia <br /> Distance to sewer line ? grout <br /> Domestic well on site - ( y/ n ) 2-1 <br /> If yes, location and distance - <br /> ft. ft. <br /> 3 ft. <br /> a —_ <br /> o <br /> SAMPLING Cwtad <br /> sac�an <br /> Holding Temperature = Pack <br /> Method — <br /> Screening Method <br /> Tracking Sheet ( y/ n ) <br /> ft. T — tt <br /> SPOILS p <br /> Storage Method of' MATERIALS/DEVELOPMENT <br /> Contamination Noted - y/ n ) ,( p C <br /> Storage Location Casing type_2 / <br /> Blank ft. Screen <br /> Slot size •b <br /> GROUTING Z Bags cement <br /> _ Buckets bentonite <br /> Depth to water 3S F Z� '" Bags sand/gravel <br /> Mix Ratios D Filter Pack type/size 2- <br /> Installation Method Surge Block: - (y <br /> Quantity Installed Discussed with geologist: - y n ) <br /> Type of method ^s <br /> EH 29 29 <br />