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MONITORING WELL INSTALLATION REPOT <br /> Date: uy� �[J CONSTRUCTION <br /> Premise Address:�3�� (� /�*�" Total Depth 2 <br /> Screen Length (from) (to) S <br /> Well No.: 2- LX' 9 Filter Pack (from) ZY (to) G <br /> Bentonite (from) 6 (to) 3 <br /> Inspector: Grout (from) 3 (to) O <br /> Drilling rig type Ce I <br /> Permit No. S� Auger O.D. —1 I.D. <br /> Completion -Stove pipe/christie box (circle one) <br /> Drilling Company:-- <br /> Driller:— casing <br /> (S height <br /> Consultant ff// � ,,....,,trom— T <br /> Geologist /V/.�1+� F C4 <br /> ABOVE-GRO(JND CHRISTI-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Q Ground Surto' <br /> Distance to sewer line /U ^" grout <br /> Domestic well on site - n ) 1 J? 1t• <br /> If yes, location and distance -= �00 e TG 0 g <br /> — - m <br /> = o <br /> _ <br /> = c <br /> SAMPLING �_ �� / slotted <br /> n ' fLs� / too on .F <br /> Holding Temperature �� , = grafi pack <br /> Method = <br /> Screening Method n <br /> Tracking Sheet - (y/n ) <br /> SPOILS / <br /> Storage Method Gly .f A d MATERIALS/DEVELOPMENT <br /> Contamination Noted= (y/ n ) Z <br /> Storage Location Casing type z21142_"7� <br /> BlankLjjfr.. Screen Zo ft. <br /> Slot size •OID <br /> GROUTING Bags cement 7— <br /> Buckets <br /> Buckets bentonite <br /> Depth to water = �'/� Bags sand/gravel <br /> Mix Ratios Filter Pack type/size -7-- <br /> Installation <br /> Installation Method Surge Block: - (y <br /> Quantity Installed Discussed with geologist: - (y n) <br /> Type of method <br /> EH 29 29 <br /> 2 G.2 3 <br />