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,MONITORING WELL INSTALLATION REPT <br /> Date: Tl�(�('l�i CONSTRUCTION <br /> Premise Addres �L� Ac'cafttl-� Total Depth <br /> Screen Length (from) (y0 (to) 019 <br /> Well No.: Filter Pack (from) 12-0 (to) <br /> Bentonite (from) (toy <br /> Inspector: Grout (from) I Le <br /> Drilling rig W <br /> Permit No. Z Auger O.D. It LD. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: (-IV)c� <br /> /�i f9 <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist s LAAO/ ' <br /> ABOVE-GROUND CHRISTY-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground S afacw �i��� <br /> Distance to sewer line IR <br /> grout <br /> Domestic well on site - ( y/ n) <br /> If yes, location, and distance - � ft <br /> • <br /> /G _� - • <br /> O <br /> SAMPLING ® 10 dotted <br /> �,Q b ��t�/ ,� ►action k = <br /> Holding Temperature gravel pack <br /> Method = <br /> Screening Method ' <br /> Tracking Sheet - (y/ n <br /> t ' tL <br /> SPOILS T N Z <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) .i 1)( V yid <br /> Storage Location Casing type � <br /> Blank 100 ft. Screen 0 -0 <br /> Slot size 0,010 <br /> GROUTING Bags cement <br /> Buckets bentoniteZ _ <br /> Depth to water Bags sand/gravel 7/ <br /> Mix Ratios A1C f u- an7*fuj Filter Pack type ize v <br /> Installation Method -�Ag4,q , R Surge Block: - / n ) � <br /> Quantity Installed Discussed with geologist: - V, n ) <br /> Type of method <br /> EH 29 29 <br />