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MONITORING WELL INSTALLATION REP* <br /> Date: GL6� 7/)o Ci. CONSTRUCTION <br /> Premise Addressz/37— Total Depth fV0 <br /> Screen Length (from) (to) <br /> Well No.. Atk!— Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: —A4 •� Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> �'� 1 height <br /> Consultant &LZAA-J Y.�Q <br /> GeleogLt2uW <br /> ABOVE GROUND <br /> COMPLETION CliMM-BOX <br /> SPECIAL PERMIT INFO. G�nd gul� COMPLEnON <br /> Distance to sewer line Qro rt <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft. <br /> n. <br /> F <br /> 0 <br /> C <br /> SAMPLING = <br /> Clotted c <br /> tx4on <br /> Holding Temperature <br /> 'VW Pack <br /> Method - o <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist. - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />