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&ONITORING WELL INSTALLATION REP <br /> Date: 111I61t)S' <br /> CONSTRUCTION <br /> Premise Address: Total Depth <br /> Well No.: /fit W —7 Screen Length (from) (to) <br /> Filter Pack (from) (to) <br /> InsPector: ���iN Bentonite (from) (to) <br /> Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: ✓^J6 L <br /> Completim oye pipe/christie box (circle one) <br /> Driller: "o-><e� casing <br /> Consultant <br /> SFr, height <br /> —EFGeologist w T <br /> COMPLETION CHAISTY-BOX <br /> SPECIAL PERMIT INFO. QCOMPLETION <br /> rnurd SuAxe <br /> Distance to sewer line orout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - ft• <br /> I Ol ft. ft• <br /> — m <br /> SAMPLING 1111-& o` <br /> slotted — c <br /> Holding Temperature seclon <br /> — <br /> Method v&W pack <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) _ <br /> I til ft. = ft. <br /> SPOILS Tb 121 <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type?�P�L k��L <br /> Blank loi fr. Screen U g, <br /> Slot size_ <br /> GROUTING Bags cement <br /> I 0 s Buckets bentonite <br /> Depth to water <br /> Bags sand/gravel <br /> Mix RatiosjhL.Aro Filter Pack type/size t lL <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> EH 29 29 Type of method <br />