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—MONITORING WELL INSTALLATION REP,—r <br /> Date: !l r//0.1 CONSTRUCTION <br /> Premise Address: d-f � �`'�'`'� Total Depth Zai Ld <br /> 5 l Screen Length (from) (to) <br /> Well No.: L Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> IA- -t <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: r � <br /> Driller: casing <br /> height —EWT <br /> Consultant ek a'�1 <br /> Geologist(A,,VC�/.0 •- <br /> ABOVE-GROUND CHRMTY43OX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sufacs <br /> 8 <br /> Distance to server line grout <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - <br /> . ft. <br /> ft. <br /> _ <br /> - C <br /> O <br /> SAMPLING 810 = c <br /> 0n — b <br /> Holding Temperature .;;:. __ gravel Pack <br /> Method —_ <br /> Screening Method r' <br /> Tracking Sheet - (y/ n) <br /> ft <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type N14 <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water, �- 0 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 />