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-.MONITORING WELL INSTALLATION REP019 <br /> Date: ` l l/'0 / CONSTRUCTION <br /> Premise Address: K9 Total Depth p <br /> Screen Length (from) (to) 2- <br /> Well <br /> Well No.: e?w �� Filter Pack (from) —(to)� <br /> Bentonite (from) (to) l <br /> Inspector: Grout (from) 1?' (to) -f 1 <br /> Drilling rig type — <br /> Permit No. © Auger O.D. g" .D. <br /> Com letion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: t / —�• casing <br /> C, <br /> Consultant kA height <br /> Geologist •- <br /> ABOVE-GROUND <br /> COMPLETIO CNAISTY-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Suriacs <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - � ft. <br /> = o <br /> o <br /> SAMPLING Slotted <br /> aacdon = <br /> Holding TemperatureV&YW= pack <br /> Method <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) <br /> ..�_ft. <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 />