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dONITORING WELL INSTALLATION REP. <br /> Date: G�I I CONSTRUCTION <br /> Premise Address: &t- L�'`� R' u ' P' Total Depth 6� <br /> Screen Length (from) (to) <br /> Well No.: F S CAP 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 /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> I T height <br /> Consultant ._ <br /> Geologist •- <br /> ABOVE-GROUND CHRMTY43OX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Suriac* <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - <br /> �R. ft. <br /> — •a <br /> c <br /> o <br /> SAMPLING 8106d <br /> section <br /> Holding Temperature S1\ <br /> pack <br /> Method SO = <br /> Screening Method r' <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) A <br /> Storage Location Casing type r} Pit/ <br /> Blank fO ft. Screen /9' ft. <br /> Slot size O.P10 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 6 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 />