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�9NITORING WELL INSTALLATION REPOK _ <br />`I <br /> i< <br /> Date: 7 / / U <br /> CONSTRUCTION <br /> Premise Address: Y460 ( A^r"' �G Total Depth <br /> Screen Length (from) (to) <br /> Well No. : Filter Pack (from) (to) <br /> r....4 <br /> � / Bentonite (from) (to) <br /> Inspector: }�J� M "� Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I,D, <br /> �R lA / 1 Completion - Stove pipe/cltristie box (circle one) <br /> . W&Rg Company: KxC 1i t4✓vj <br /> Driller: <br /> / I I casing �twT <br /> Consultant_ r� '�11 W � height <br /> Geologist <br /> ABOVEaGROUND <br /> COMPLETION CHRMTY41OX <br /> SPECIAL PERMIT INFO. CCMPLETICN <br /> ® Ground SuAscs <br /> Distance to sewer line grout <br /> Domestic well on site - ( y / n ) <br /> If yes, location and distance - - fto <br /> ft ft- <br /> SAMPLING = o` <br /> dorc� — c <br /> soden <br /> Holding Temperature <br /> Method = G•svi� Pack <br /> a; <br /> Screening Method <br /> Tracking Sheet - ( y / n ) <br /> n. = fL <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n } <br /> Storage Location Casing type <br /> Blank ft. Screen Ct. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y / n ) <br /> Quantity Installed Discussed with geologist: - ( y / n ) <br /> EH 29 29 Type of method <br />