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MONITORING WELL INSTALLATION REPOrnf <br /> Date: /o 2,6 —6Z f I�,7-16` CONSTRUCTION <br /> Premise Address: e N �7t� Total Depth_ J` ' <br /> iScreen Length (from) (to) O <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) 35 <br /> Inspector: Grout (from) 35& (to) O <br /> ��' � Drilling rig type DK8'1 <br /> Permit No. J ,fig y' Auger O.D. 6- I.D. <br /> �� Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: / F casing <br /> height <br /> Consultant Cw <br /> GeologistC ' ABOVE-GROUND <br /> 00WFLETCN COMPLE71 <br /> CMPL <br /> SPECIAL PERMIT INFO. Ground Surfac* <br /> Distance to sewer line L grout <br /> Domestic well on site - ( y Un ?jS�. ft. <br /> If yes, location and distance - 3C tL <br /> .ft. <br /> — ' m <br /> = m <br /> o <br /> SAMPLING �lottad <br /> Holding Temperature s- 9 a(Pack <br /> Method '— <br /> Screening Method C _ <br /> Tracking Sheet - ( y AD +5 <br /> ft. ft. <br /> SPOILS <br /> Storage Method 56W MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( n Q <br /> Storage Location G Casing type ?i t -$'�� ! ✓nn <br /> Blank 4o ft. Screen <br /> Slot size . 0/0 <br /> GROUTING Bags cement <br /> _ Buckets bentonite Zw4,c-4-.�r- <br /> Depth to water Bags sand/gravel Z—• <br /> Mix Ratios Y Filter Pack type/size_ t 7— <br /> Installation <br /> Installation Metho /YAW— Surge Block: - On ) n <br /> Quantity Installed ll�f . Discussed with geologist: - (y <br /> Type of method <br /> EH 29 29 <br /> � <br /> z7o C, <br /> 0 � <br />