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Wi-,'ONITORING WELL INSTALLATION REPO <br /> Date: 4 � v' CONSTRUCTION <br /> Premise Address: Total Depth <br /> /e&W Screen Length (from) (to) (00 <br /> Well No.: Filter Pack (from) IV (to) 55.5 <br /> Bentonite (from) X5.5 (to) 5-2-- <br /> Inspector: <br /> 2— <br /> Inspector: Grout (from) 452— (to) b <br /> D ��31� Dulling ng typ `�E 5 <br /> Permit No. Auger O.D. T I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultan <br /> v <br /> T <br /> Geologist A /ABOVE-GROUND <br /> CONFLETION C4A1SrY-80X <br /> OMP ION <br /> SPECIAL PERMIT INFO. /fit/� Ground Surtxs <br /> Distance to sewer line <br /> ,Lsv grout <br /> Domestic well on site - (y/ n) <br /> If yes, location and distanc ft. <br /> 55.5 ft, <br /> _ft. <br /> = m <br /> _ <br /> _ a <br /> SAMPLINGf�ko slotted = <br /> tl aac5on <br /> `=tJT" = <br /> Holding Temperature <br /> Method —_ <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted (y n V' 5� 4 Q� <br /> Storage Location 6P% Casing type r <br /> Blank (,L7 ft. Screen tO ft• <br /> Slot size t)1 <br /> GROUTING �7MBags cement 1- <br /> I Buckets bentonite 1 2 U <br /> Depth to water 2 Bags sand/gravel 300" <br /> Mix Ratios q7 + VJ Filter Pack type/size l Z— <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed 50 r Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />