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'510NITORING WELL INSTALLATION REPO,..-,. <br /> Date: l rl� CONSTRUCTION ` <br /> Premise Address: Total Depth ( J <br /> �' �� Screen Length (from) (to) ����--- <br /> Well No.: Filter Pack (from) (to)_-��— <br /> Bentonite (from) Z�_(to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type GIGGLE JS <br /> Permit No. Auger O.D. ��_ I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: f fA,,�- " casing <br /> height <br /> Consultant f LJ <br /> Geologist <br /> ABOVE-GROUND <br /> CO MPLE NDN CMR tSTY-80X <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line L > Grog <br /> Domestic well on site - ( y/ n ) <br /> ft. <br /> If yes, location and distance <br /> _ a <br /> SAMPLING dotted ^ — <br /> sac�on <br /> Holding Temperature = 9MV94 Pack <br /> Method = <br /> Screening Method _ <br /> Tracking Sheet ( y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) +11 <br /> Storage Location Casing type <br /> Blank 3c> ft. Screen_ ft. <br /> Slot size . 0/01, <br /> GROUTING Bags cement -7Fm i i <br /> Q Buckets bentonite <br /> Depth to water 0 Bags sand/gravel W) VIPO <br /> Mix Ratios Filter Pack type/size IZ <br /> Installation Method Q�its•,,cs/ " dtyK C?,u� a Surge Block: - ( n <br /> Quantity Installed56,- 1- Discussed with geo ogist: <br /> Type of method <br /> EH 29 29 <br />