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OONITORING WELL INSTALLATION REPOO <br /> Date: ,/�'/�� CONSTRUCTION C! <br /> Premise Address: 40--.5r Total Depth �7 <br /> Screen Length (from) 5Y (to) Z <br /> Well No.: C�Gf/ -� Filter Pack (from) 57q (to) Z� <br /> Bentonite (from) Z4- (to) — <br /> Inspector: Grout (from) L�(to) / <br /> Drilling rig type F'3- <br /> Permit <br /> SPermit No. Auger O.D. /y I.D. 8 <br /> � C. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: T casing <br /> ITT height <br /> Consultant MIMI FT <br /> Geologist �a( •- T <br /> ABOVE-GROUND CNRISTY-BOX <br /> COMPLETION COMPLE710 <br /> SPECIAL PERMIT INFO. Ground SuAace <br /> Distance to sewer line I grout <br /> Domestic well on site - (y <br /> If yes, location and distance - 2 tt. <br /> ft <br /> rt. <br /> = m <br /> = m <br /> SAMPLING slotted =_ c <br /> p _ "cion <br /> Holding Temperaturegrivig pack <br /> Method = <br /> Screening Method = <br /> Tracking Sheet (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - y nl / '►la�eGl.•. 41- 6 rtSS�Ot.�a.` <br /> Storage Location '� }� Casing type (O <br /> / Blank L,, ft. Screen 25 ft. <br /> Slot size . 0-90 <br /> GROUTING Bags cement f- 97Z t <br /> Buckets bentonite /� <br /> Depth to water Bags sand/gravel <br /> Mix Ratios + 2[c.'4� Filter Pack typeee <br /> Installation Method tle.•.L ��A Q Surge Block: - n ) <br /> Quantity Installed 50 ftLf T- W -f- (S / Discussed with geologisty- (y n ) <br /> Type of method <br /> EH 29 29 <br />