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MONITORING WELL INSTALLATION REPOnf <br /> Date: Ai� /Z 1'•oo 3 CONSTRUCTION <br /> Premise Address: bktNj T=C Total Depth <br /> p Screen Length (from) o (to) 2-2-157 ZS <br /> Well No.: ,`� O ��LL Filter Pack (from) O (to) 2-2-157Bentonite (from) 2Z-5 (to) ?-A> <br /> Inspector: Grout (from) (to) d <br /> Drilling rig <br /> Permit No. Auger O.D. 1 I.D. <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant SLcGOiC <br /> Geologist <br /> ABOVE-GROUND CHS TY43OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> 7 grout <br /> Distance to sewer line <br /> Domestic well on site - (y� ZO• ft. <br /> If yes, location and distance - ZL.S ft• <br /> ft. <br /> _ m <br /> C <br /> o <br /> SAMPLING slotted <br /> section :;• _ � <br /> Holding Temperature 411,4 <br /> gm��pack <br /> Method /►�� <br /> Screening Method Na '— <br /> Tracking Sheet - (y/n) <br /> ft. ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) b%' Sc k 4o , is <br /> Storage Location Casing type <br /> Blank 25 ft. Screen.15- ft. <br /> Slot size 0. OZD.1 <br /> GROVDNG Bags cement <br /> t Buckets bentonite <br /> Depth to water <br /> ^ ,�j Bags sand/gravel F.S <br /> Mix Ratios 0 Com/ Filter Pack type/size 3 <br /> Installation Method Surge Block: - (y <br /> Quantity Installed Discussed with geologist: - O'n) <br /> Type of method t'"J ff— - <br /> EH 29 29 <br /> 0 3 ASF <br />