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.MONITORING WELL INSTALLATION REP, .' <br /> Date: ' �P v CONSTRUCTION <br /> Premise Address: f- 6 d, Total Depth <br /> ^ Screen Length (from) (to) <br /> Well No.: 174 Filter Pack (from) -(to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) O <br /> 3 2 / Drilling rig type -ft /O&X.. <br /> Permit No. Auger O.D. 9� I.D. + <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: t casing <br /> height <br /> Consultant <br /> Geologist .. <br /> ABOVE-GROUND <br /> COMPLETION CtiR7ST OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfw* <br /> Distance to sewer line grout <br /> Domestic well on site - (y S <br /> If yes, location and distance- ft. <br /> ft' <br /> �. tc d <br /> a <br /> = m <br /> SAMPLING slctwd = x; <br /> ax5on =_ <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 ) 2-,'(S <br /> �r� , <br /> Storage Location Casing type <br /> Blank ft. Screen <br /> Slot size -d LCA <br /> GROUTING Bags cement <br /> i Buckets bentonite / <br /> Depth to water Bags sand/gravel 3 Z <br /> Mix Ratios Filter Pack type/size 2- <br /> Installation Method Surge Block: - (y n <br /> Quantity Installed Discussed with geo ogist: - (y <br /> Type of method <br /> EH 29 29 <br />