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MONITORING WELL INSTALLATION REPORL.d <br /> Date: H-3 CONSTRUCTION <br /> Premise Address:��� mold Total Depth �D3 <br /> Screen Length (from) LQ ;_(to)� <br /> Well No.: .R�- m e -s Filter Pack (from) �3 (to) <br /> Bentonite (from) (to) <br /> Inspector: , Grout (from) (to) <br /> Drilling rig type o4r­ ka(l <br /> Permit No. << Auger O.D. 13? I.D. <br /> CAS x Completion - Stove pipe/ stie bo (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> lillheight <br /> Consultant ` n if],I <br /> Geologist ��, T <br /> i <br /> ABOVE-GACUND CtiAJS _wx <br /> COWLETION COMPLETICN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line Grout <br /> Domestic well on site - (y/ n) �ft. <br /> If yes, location and distance - q� ft. <br /> SAMPLING n slorad = <br /> secycn <br /> Holding Temperature 13 IX- <br /> 9MVW P <br /> Method — Pack <br /> AE- <br /> Screening Method <br /> Tracking Sheet nTT <br /> ) :.x — <br /> �ft. <br /> SPOILS <br /> r (_ <br /> Storage Method kMATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n << ,r <br /> Storage Location Casing type a' �1 C' <br /> Blank 'R3 ft. Screen ->f-) ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel _ <br /> Mix Ratios I kgrw -�b -7 a Filter Pack type/size m c CLQ,-6" 3 <br /> Installation Method c�• Surge Block: -a/ 11 ) <br /> Quantity Installed -3 Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />