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MONITORING WELL INSTALLATION REP <br /> Date: Zlo ZOOS CONSTRUCTION t <br /> Premise Address:: �� Total Depth <br /> Well No.: ��Z Screen Length (from) (to) <br /> Filter Pack (from) (to) <br /> Inspector: Bentonite (from) (to) <br /> Grout (from) (to) O <br /> fiY) / Z. 3 Drilling rig type <br /> Permit No. tD/ <br /> Auger O.D. <br /> Drilling Company: �' <br /> Completion - Stove pi a/christie box (circle one) <br /> �{/p W <br /> Driller: f` L <br /> casing <br /> height <br /> Consultant _ //i�/Z <br /> Geologist �V%41 S <br /> ABOVE-GROUND <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Grourd Surface <br /> COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y n <br /> If yes, location and distance - ft• <br /> ft. <br /> Uft <br /> q <br /> O <br /> C <br /> SAMPLING = E <br /> sectio = $ <br /> �- / �- <br /> Holding Temperature � suction __ vivo'Pack- - 3-976 _ <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> 55 ft. = n. <br /> SPOILS 56 <br /> Storage Method M_ ATERIALS/DEVELOPMENT <br /> Contamination Noted - n ) I D�� I n <br /> Storage Location nG C/Pub 1Jdt� M Casing type .7 f sex• <br /> —� 46 <br /> Blank a3c.� ft. Screen ft. <br /> Slot size . 020 <br /> GROUTING Bags cement <br /> y Buckets bentonite <br /> Depth to water 3` Bags sand/gravel <br /> Mix Ratios- -5 Pack type/size <br /> Installation Method o LZSurge Block: - (y <br /> Quantity Installed Discussed with geologist: - (y/n <br /> Type of method <br /> EH 29 29/�� <br /> J <br /> ju �j � s <br />