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.MONITORING WELL INSTALLATION REPOni <br /> Date: SCONSTRUCTION <br /> Premise Address: , Total Depth a <br /> Screen Length (from) (to) ZS <br /> Well No.: -t Filter Pack (from) 3 (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Aox Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: LCONF ) <br /> ConsultantGeologist CHRZ Y4= <br /> COMPLETICN <br /> SPECIAL PERMIT INFO. Ground Surfacs <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) 1 if - ft• <br /> If yes, location and distance - Z! ft• <br /> .eft. <br /> = m <br /> O <br /> C <br /> O <br /> SAMPLING sloUd <br /> secton — 1 <br /> Holding Temperature �„w Pack <br /> Method = <br /> Screening Method = <br /> Tracking Sheet - ( y/ n ) 3 _ <br /> o ft. ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) t�` <br /> Storage Location Casing type Z r V <br /> Blank 23 ft. Screen L$ ft• <br /> Slot size .OZ <br /> GROUTING Bags cement <br /> Buckets bentonite 0 <br /> Depth to water — Bags sand/gravel 52- <br /> Mix <br /> 2Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( pog�st: <br /> Quantity Installed Discussed with ge - (yo <br /> Type of method <br /> EH 29 29 <br /> q�lo I / r � ,� � <br />