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'%.MONITORING WELL INSTALLATION REP"Od <br /> � U U "[ CONSTRUCTION <br /> Date: <br /> Total Depth Z� <br /> Premise Address: Screen Length (from) (to)7r - <br /> ��"� - <br /> Filter Pack (from) (to) <br /> Well No.: <br /> n Bentonite (from) (to) ,.,� <br /> Inspector: Grout (from) - (to)2 U <br /> Drilling rig type <br /> Permit No. �, r"l� Auger O.D. T.D. <br /> Completion - Stove pipe/christie box {circle one) <br /> Drilling Company: <br /> Driller: casIng <br /> height <br /> Consultant --nf; <br /> Geologist V <br /> AIZVE-GROUND <br /> COMPLETION &CHRMSTYY�-80' <br /> SPECIAL PERMIT INFO. around Surface <br /> groutDistance to sewer line <br /> Domestic well on site - y n) 1 tP n, <br /> If yes, location and dis ce - I}, <br /> 0 <br /> SAMPLING sbrted <br /> sedan <br /> Holding Temperature gravel park <br /> w'• — <br /> Method 1� — <br /> Screening Method IG _ <br /> - Tracking Sheet y n 615 <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n .f `t <br /> Storage Location $type Kb - <br /> Blank Ah ft. Screen__1 ft- <br /> Slot size <br /> GROUTING Bags cement <br /> / <br /> I ck hentoni te VfV4X <br /> Depth to water �' �i'Z`�'`�� Bags a gravel <br /> Filter Pack type/size <br /> Mix Ratios <br /> Installation Met5od i Surge Block: - (�y) n ) <br /> Quantity Installe 12 Discussed with geologist: - (y n J) <br /> Type of method v <br /> EH 24 29 <br /> 5 <br /> i <br />