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MONITORING WELL INSTALLATION REP <br /> Date:_ 12 l _ CONSTRUCTION <br /> Premise Address:_ 7 Total Depth r <br /> � � <br /> + "�" Screen.Length (from) —(to)' <br /> Well No.: _ Filter Pack (from) (to) <br /> Bentonite (from} (to) <br /> Inspector Grout (from) (to)4 <br /> Drilling rig type <br /> Permit No.—.I' Auger O.D. I.D. <br /> _ $. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:60 rvaci <br /> Driller: Dc/n �! _ODS casing y <br /> l � height <br /> Consultant,CP�/Ylt. W <br /> Geologist B 1'11 f f.rill rm INOlo Z iwT <br /> r -- '- y,»' - ABOVE-GROUND CrRLM-sax <br /> E COMPLETION <br /> COMPLETION <br /> SPECIAL PERMIT INFO. a ... : .-. Ground Surfacs <br /> Distance to sewer line <br /> Domestic well on site - (y/ n• <br /> ILL . _ .. �. <br /> If yes, location and distance - pip ft• <br /> 9 f0*0 SPP► - ft. <br /> ,a <br /> SAMPLING2 slotted — J <br /> "cdon <br /> Holding Temperature Fri . .. gm„el Pack t <br /> Method h8 31 2 <br />} Screening Method P I Q E <br /> Tracking Sheet (�' n )_ 0008:� <br /> SPOILS Ir5 CSS. Pp,r <br /> ,L�ZDk <br /> K4-4— 5tr-p cattA <br /> Storage Method—VI '� r` 3QJ iMiRIALS/DEVELOPMENT <br /> Contamination Noted - 0/ n } _ 2`(-. obucovs dmr-olO W*On <br /> Storage Location g type <br /> 7� - tl, Casin e <br /> 28 Blank ft. Screen <br /> _ ft. <br /> 16M -wned M W S r Slot size <br />+ GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 1 Bags sand/gravel k <br />` f Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n) ,f <br /> Quantity Installed °' Discussed with geologist: (y/ n ) <br /> Type of method <br /> 1 EH 29 29 <br />