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MONITORING WELL INSTALLATION REP0KT <br /> Date: g� �� CONSTRUCTION ® 6GBQ <br /> Premise Address: 393/ �wl Total Depth 75 q,10 <br /> Svc Screen Length (from) !S; 5 (to) 7s— <br /> Well No.: Filter Pack (from) 'S(to)SZ <br /> j� Bentonite (from) Sv (to) S 2 r <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. 5r-e OG Z 91S/S XS-45-10/ Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> IffT <br /> height <br /> Consultant // <br /> Geologist 'Zkil - <br /> ABOVE-GROUND CFWISiY$OX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Gr«ud Surfxr <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> n• <br /> If yes, location and distance - <br /> _ m <br /> — m <br /> Sc <br /> — s <br /> SAMPLING dotted = c <br /> wc'ion - <br /> Holding Temperature = _ �9ack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen h. <br /> Slot size /7ZO <br /> GROUTING Bags cement <br /> Buckets bentonite Chid, S <br /> Depth to water Bags sand/gravel leo to.Ke5 a <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 /> VE - 3 <br />