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'MONITORING WELL INSTALLATION REPOtZ <br /> Date: CONSTRUCTION <br /> Premise Address: l T / Total Depth <br /> Screen Length (from) 3(0 (to)_k <br /> Well No.: Filter Pack (from) (o (to)_ ``f 7 <br /> Bentonite (from) -S (to) 2-(-'S <br /> Inspector: Grout (from) 71- S (to) 2-` (� <br /> ��O�� L�/ Drilling rig type <br /> Permit No. Auger O.D. T I.D. i <br /> Drilling Comp <br /> Completion - Stove pipe/christie box (circle one) <br /> Company: <br /> �� ,� <br /> Driller: / Z casing <br /> (bLETION <br /> eight <br /> Consultant 6t.Gv Z` -�• <br /> Geologist <br /> CHAlM43CX <br /> COMPLETICN <br /> SPECIAL PERMIT INFO. ^+, (around Suriact <br /> Distance to sewer line / SD/ grout <br /> Domestic well on site - (y<Dn 24.5 ft <br /> If yes, location and distance - ZI S ft <br /> = m <br /> C <br /> SAMPLING ' ° <br /> slotted = C I <br /> section = <br /> Holding Temperature •t �(�, <br /> Method g I* Pack <br /> Screening Method _ <br /> Tracking Sheet ( y/ n ) <br /> IF <br /> SPOILS p 37 <br /> Storage Method SS ,�GtJ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n ) t\ <br /> Storage Location_ A-A..h 30 ^3s Casing type 2--t 2J, ` 6 NO- <br /> Blank 2(b ft. Screen 10 ft. <br /> Slot size 'c)1&'1 <br /> GROUTING Bags cement 5 y' /i <br /> !/ Buckets bentonite Z '�1e <br /> Depth to water —_ 7 G Bags sand/gravel 3 5D <br /> Mix Ratios t Filter Pack type/size 2-112- <br /> Installation <br /> - 12Installation Method lvY.dC " Surge Block: - (y/ n ) <br /> Quantity Installed—" Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />