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ONITORING WELL INSTALLATION REPO <br /> Date: tt CONSTRUCTION <br /> Premise Address: Ssk� Total Depth X05 <br /> Screen Length (from) /0 (to) Po L <br /> Well No.: Filter Pack (from) /0 (to) /dd. <br /> Bentonite (from) A�d.3 (to) <br /> Inspector: Grout (from) (to) o <br /> Drilling rig type L+4KGTS <br /> Permit No. Auger O.D. F T I.D. 4 <br /> C Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: 6 ,,// I` y casing <br /> height <br /> Consultant 61451e <br /> - <br /> Geologist 9.6--e- E-Lli� _ <br /> ABOVE-GROUND CHR* Y-BOX <br /> COAFL.ETION <br /> SPECIAL PERMIT INFO. GrourdBurlact <br /> Distance to sewer line LSo grout <br /> Domestic well on site - (y/ n) 1 � . n <br /> If yes, location and distance - /O4,3 g. <br /> �k. <br /> _ O <br /> N <br /> O <br /> SAMPLING slatted v <br /> on <br /> Holding Temperature <br /> Method _ - <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> tt. — tt. <br /> SPOILS <br /> Storage Methodsaw <br /> MATERIALS/DEVELOPMENT <br /> Contamination Noted - n ) / e I✓C <br /> Storage Location Casing type <br /> Blank /dZ ft. Screen___L ft. <br /> Slot size GZo <br /> GROUTING Bags cement qf <br /> Buckets bentonite 17s- <br /> Depth <br /> s- <br /> Depth to water '/L Bags sand/gravel zoo <br /> Mix Ratios idoaif C t t 3 Filter Pack type/size <br /> �s� /Z <br /> Installation Method .0 Surge Block: - (y fo <br /> Quantity Installed f Discussed with geologist: - (y n) <br /> Type of method <br /> EH 29 29 <br /> bio-a op /7 <br />