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----iA0NITORING WELL INSTALLATION REPOT <br /> Date: u �` CONSTRUCTION <br /> Premise Address: 01 PJW 'n.r..p( QW Total Depth <br /> Screen Length (from) (to) <br /> Well No.: 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: <br /> Driller: casing <br /> height <br /> Consultant_ —WW-f <br /> 17 <br /> Geologist •- <br /> ABOVE-GROUND CHiRISTY480X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface + <br /> Distance to sewer line gfOA <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - ft. <br /> . ft. <br /> ft. <br /> r <br /> BVI L !vv' .��-L <br /> SAMPLING slotted <br /> secton <br /> Holding Temperature gmvel Pack <br /> Method "" <br /> Screening Method ` <br /> Tracking Sheet - (y/ n ) __ <br /> ft. �` — ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <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 />