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-MONITORING WELL INSTALLATION REPT. . <br /> Date:----� �` / !0 CONSTRUCTION <br /> Premise Address: J w C' Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) —(to)� <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) O <br /> Drilling rig type - <br /> Permit No. Cl Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (c cle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist •- <br /> ABOVE-GROUND <br /> COMPLETCN CNAfST'Y-80 <br /> P <br /> SPECIAL PERMIT INFO. /J Ground Suiaas <br /> Distance to sewer line '7v�� / grout <br /> Domestic well on site - (y <br /> If yes, location and distanc - G ft. <br /> = m <br /> _ <br /> — _ a <br /> SAMPLING slotted = <br /> Holding Temperature <br /> Method = P <br /> ack <br /> Screening Method =_ <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n ) t < �� <br /> Storage Location Casing type <br /> Blank ft. Screen <br /> Slot size -6Z'6 <br /> GROUTING Bags cement <br /> / Buckets bentonite <br /> Depth to water / Bags sand/gravel 3 <br /> Mix Ratios z - Filter Pack type/size 7— <br /> Installation <br /> Installation Method Surge Block: - (y n <br /> Quantity Installed Discussed with geo ogist: - (yn ) <br /> Type of method <br /> EH 29 29 <br />