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040NITORING WELL INSTALLATION REPOni <br /> Date: 2-001 CONSTRUCTION <br /> Premise Address: � Total Depth <br /> / v Screen Length (from) (to) <br /> Well No.: ��d/� Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Completion - Stove pipe/christie box (circle one) <br /> Comp�an'y':.- J Driller: 1l casing <br /> � � height <br /> Consultant T <br /> Geologist 7i1LGGTV T <br /> ABOVE-GROUND <br /> CONFLETION CHA75TY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. / Ground Surface <br /> Distance to sewer line N groin <br /> Domestic well on site - ( y n aZ <br /> If yes, location and distance - <br /> n. <br /> ISR <br /> c6t"o6 <br /> • = a <br /> = m <br /> — o <br /> SAMPLING slatted - E <br /> Becton _ <br /> Holding Temperature <br /> Method gr'�pack <br /> Screening Method = ": <br /> Tracking Sheet - (y/ n ) <br /> LJn <br /> SPOILS <br /> Storage Method ��� MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y ' <br /> Storage Location �d,G k+ !k�y' Casing type Z �� V <br /> Blank Z'W ft. Sween ft. <br /> Slot size . 0,U) <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water l Bags sand/gravel <br /> Mix Ratios fi (�f Filter Pack type/size <br /> Installation Method d4H Surge Block: - (y AV <br /> Quantity Installed Discussed with geologist: - (Dn ) <br /> Type of method <br /> EH 29 29 <br />