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'MONITORING WELL INSTALLATION REPO,, <br /> Date:_0r �{� CONSTRUCTION <br /> Premise Address: \ al Depth a �S <br /> nnn^ UUU��� Screen Length (from) a (to) <br /> Well No.: Jam' Filter Pack (from) (to) `7 <br /> Bentonite (from) S (to) <br /> Inspector C " Grout (fropt) (to) o ce <br /> Drilling rig type G <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/duistie box (circle one) <br /> Drilling Company: <br /> Driller: 17� casing <br /> T height <br /> -- CZ 2 <br /> ABOVE-GACUND CtffitSiY-80X <br /> W MPLEifON COMPL-EnCN <br /> SPECIAL PERMIT INFO. Ground Satan <br /> Distance to sewer line <br /> grout <br /> Domestic well on sitey n) �Z . ft. <br /> If yes, location and di tante - ft <br /> ai <br /> = o <br /> = c <br /> SAMPLING stoned <br /> socicn —_ <br /> Holding Temperature = �Y,t Pack <br /> Method = <br /> Screening Method r <br /> Tracking Shcet - (y/ n ) <br /> tt. t1. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) - f' <br /> Storage Location Casing e F v C <br /> Blank�ft. Screen___5 h. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />