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_dONITORING WELL INSTALLATION REP. <br /> Date: �� /�O �� O CONSTRUCTION <br /> Premise Address: T f• y -f�`'� Total Depth 2-0 <br /> Screen Length (from) Zb (to) !O <br /> Well No.: Filter Pack (from) ?•o (to)__V_ <br /> Bentonite (from) -(to <br /> Inspector: Grout (from) (to) CU <br /> Drilling rig typeL/2 — <br /> Permit No. Auger O.D. P I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> / <br /> am <br /> Driller: ljrj� casing <br /> height <br /> Consultant <br /> Geologist •- <br /> ABOVE-GROUND ��,� <br /> OONFLETION C ON <br /> SPECIAL PERMIT INFO. around Surface <br /> Distance to sewer line grout <br /> Domestic well on site - ( y 4 <br /> ft. <br /> If yes, location and distance - <br /> f?J <br /> ft. <br /> 9 ft. <br /> O <br /> C <br /> O <br /> SAMPLING slotted '" <br /> socton <br /> Holding Temperature vd <br /> ack <br /> Method = P <br /> Screening Method = <br /> s <br /> Tracking Sheet - (y/ n ) _ <br /> SPOILS - e <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - n ) <br /> J �� <br /> Storage Location /,���-�-�-r C� Casing typeyl IPC <br /> Blank /D ft. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water f Bags sand/gravel 3 2 <br /> Mix Ratios 7�0 T /• t z z /'6-Z Filter Pack type/size -=Z- <br /> Installation <br /> ZInstallation Method Surge Block: - (y'ln <br /> Quantity Installed Discussed with geologist: - ( y <br /> Type of method <br /> EH 29 29 <br />