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MONITORING WELL INSTALLATION REPOn f <br /> Date: �/i Z6, CONSTRUCTION <br /> Premise Address:. N• /'t4 4 Total Depth <br /> Screen Length (from) (to) ZZ— <br /> Well No.: �W Z' Filter Pack (from) 3'L (to) 7,0 <br /> Bentonite (from) 1-0 (to) tF <br /> Inspector: Grout (from) (to) <br /> Drilling rig type �IC- 1 <br /> Permit No. /` ! Auger O.D. /o I.D. (o <br /> f Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: (/ <br /> Driller: �`'�'b Af �t 4�h/L; 5 casing <br /> height <br /> Consultant G��. <br /> Geologist <br /> ABOVE-G R CUN D <br /> CO MPLEf{O N CNRtSTY-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sula" <br /> Distance to sewer line grout <br /> Domestic well on site - ( y n /S <br /> ft. <br /> If yes, location and distance— � <br /> 2� tL <br /> �ft. <br /> C <br /> O <br /> SAMPLING slotted <br /> socson <br /> Holding Temperature = Pack <br /> Method <br /> Screening Method <br /> r; <br /> Tracking Sheet - (y/ n ) <br /> 32, n. <br /> SPOILS <br /> Storage Method � MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) it <br /> Storage Location Casing type <br /> Blank--,Z2– _ft. Screen /0 ft. <br /> Slot size <br /> GROUTING Bags cement <br /> i� Buckets bentonite / C41--'a <br /> Depth to water Bags sand/gravel <br /> Mix Ratios ?' '' Filter Pack type/size 2 <br /> Installation Method Surge Block: - (y n) <br /> Quantity Installed Discussed with geo ogist: - y/n�I <br /> Type of method C/ <br /> EH 29 29 <br /> `{ rZ- <br /> v,�,� <br />