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kONITORING WELL INSTALLATION REPT <br /> Date: ef-Z'0- V / CONSTRUCTION <br /> Premise Address: 1(J Total Depth <br /> ^ Screen Length (from) �o (to) O <br /> Well No.: J{ i� Filter Pack (from) (03- (to) <br /> Bentonite (from) &S— (to) '57 <br /> Inspector: 0, Grout (from) (to) <br /> p� Drilling rig type <br /> Permit No. SK 60 01002e Auger O.D. S I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: 12003 t casing <br /> Consultant M1 I <br /> T height <br /> Geologist W. T <br /> ABOVEGROUND (iyo <br /> -BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground SuAxs <br /> Distance to sewer line �' grout <br /> Domestic well on site - (y/ n ) S n. <br /> If yes, location and distance - /_s 2 n. <br /> = m <br /> — o <br /> _ m <br /> — o <br /> SAMPLING Slotted = 8 <br /> wc5on <br /> Holding Temperaturegraw,pyo <br /> Method =_ <br /> Screening Method = <br /> Tracking Sheet - (y/ n) 1D <br /> tt, tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen fr. <br /> Slot size .07-0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water / / Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method S Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br /> �S-Z(P �• ZD • 4/ <br />