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*ONITORING WELL INSTALLATION REPO <br /> Date: �Z/^� j CONSTRUCTION <br /> �/ /� 7 / C/�*/ }� Total De th <br /> Premise Address:�J� /�� �/"" ""Y,` J / � P <br /> Screen Length (from)-(to)- <br /> Well <br /> from) (to)Well No.: Filter Pack (from)-(to)- <br /> Bentonite <br /> from) (to)Bentonite (from)-(to)- <br /> Inspector: <br /> from) (to)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: v✓�Q7 G / i� f /� �3- �/� <br /> Driller: L �� ' � ��� CJ casing <br /> height <br /> f I <br /> Consultant pp^^ U� <br /> Geologist a&4c yl T <br /> ABOVE-GROUND CHRISTY43OX <br /> CONFLETION COMPLETION <br /> SPECIAL PERMIT INFO. Grourd Surf'°° <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) �_ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> — o <br /> C <br /> O <br /> SAMPLING slotted _ B <br /> sac.on <br /> Holding Temperature = gravel Pads <br /> Method <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) =_ <br /> SPOILS <br /> Storage Method MATERIALSIDEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />