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*NITORING WELL INSTALLATION REPO* <br /> Date: 1 - CONSTRUCTION <br /> Premise Address:15D Lkal, M V Total Depth <br /> s��-�_ Screen Length (from) (to) <br /> Well No.:�t7' I' 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 /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: C7��1 G1 <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist - <br /> ABOVE•GROUNO CHAISTY BOX <br /> COMPLETX)N COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sulam <br /> Distance to sewer line (mak_ grout <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - <br /> O <br /> SAMPLING slotted B <br /> awdon <br /> Holding Temperaturegravel= P <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> SPOILS b SS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> N <br /> Storage Location T' lank ( r ft. t Screen C ?�r'J lO ft. <br /> Slot size ().57f0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 00 <br /> Mix Ratios Filter Pack type/y' e <br /> Installation Method Surge Block: - ( (y n ) <br /> Quantity Installed Discussed witk eeologist: - ( / n) <br /> Type of method l/ <br /> EH 29 29 <br /> GE <br />