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MONITORING WELL INSTALLATION REPO <br /> Date: WAU,.( ', OV CONSTRUCTION <br /> Premise Address: Total Depth 1 0 <br /> Screen Length (from) 10 (to) tO 2- <br /> Well <br /> Well No.: Filter Pack (from) 104 (to) f --- <br /> Bentonite (from)__ to_(to) <br /> Inspector: Grout (from) 9B (to) O <br /> Drilling rig type M <br /> Permit No. Auger O.D. 19 I.D. �— <br /> h n Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: o�G�D L <br /> Driller: casing <br /> IffT height <br /> Consultant 1�i1l�yi� <br /> TM <br /> Geologist s <br /> ABOVE-GROUND -80 <br /> COMPLETION COMP ON <br /> SPECIAL PERMIT INFO. Ground Sura° <br /> i <br /> Distance to sewer line Sd grout <br /> Domestic well on site - (y O <br /> If yes, location and distance - U Ift. <br /> C <br /> SAMPLING slatted = E <br /> 0 <br /> &#cion <br /> Holding Temperature C' _ gravel PaCK <br /> Method <br /> Screening Method 0V'44 <br /> Tracking Sheety n ) /a +, <br /> n. n. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted -Cp n ) /,, 'Ale <br /> Location ��I '� Casing type <br /> Blank 102 ft. Screen Z fr• <br /> Slot size • O?� <br /> GROUTING Bags cement�— <br /> Buckets bentonite i 3U <br /> Depth to water 133 ¢+ Bags sand/gravel <br /> Mix Ratios -f 4 Irl t 3% Filter Pack type/siz�e � -Z2— <br /> Installation <br /> Z <br /> Installation Metho Surge Block: - (y< p <br /> Quantity Installed 3i t SOt 030 t SD t'SD Discussed with geologist: - (y,nn <br /> Type of method <br /> EH 29 29 <br />