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MONITORING WELL INSTALLATION REP <br /> Date: ZZ 0 CONSTRUCTION <br /> Premise Address: 0 Total Depth <br /> Screen Length (from) (to) <br /> Well No.: MW S Sat 5`N .C�41 V Filter Pack (from) (to) <br /> I Bentonite (from) (to) <br /> Inspector. .1��^" P Grout (from) (to) <br /> Ins <br /> P Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: height <br /> Consultant 2'L'Q' '' T <br /> Geologist Wim`¢ / Q _S ABOVEGROUND T <br /> " U COMPLETION cOMPLETIOX <br /> COMP{.ETION <br /> SPECIAL PERMIT INFO. �� Surtax <br /> ori— <br /> Distance to sewer line43 <br /> Domestic well on site - (y/ n) ft <br /> If yes, location and distance - n <br /> 7 ft. <br /> O <br /> SAMPLING sloasd = c <br /> Holding Terature sac9on <br /> Method l 5 / P55 <br /> Screening Method Ll <br /> Tracking Sheet - (y/ n) :e _ <br /> 17 tL _ fL <br /> )-117L <br /> SPOILS <br /> Storage Method �Ci - MATERIALS/DEVELOPMENT <br /> Contamination Not d - 1 D Casing type ��I PIIS <br /> Storage Location Blank----7—ft. Screen D h• <br /> Slot size r7 0 I Q — <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water�� �'S Bags sand/gravel L <br /> s Filter Pack type/s' <br /> Mix Ratio <br /> Surge Block: - (y n <br /> Installation Method <br /> Quantity Installed Discussed with geologist: - Q} / n ) <br /> Type of method <br /> EH 29 29 <br />