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MONITORING WELL INSTALLATION REP <br /> Date: I CONSTRUCTION <br /> r <br /> Premise Address: Total Depth 1 DL <br /> Screen Length (from) 11 Z (to) /oL <br /> Well No.: Filter Pack (from) S9 (to) /07— <br /> Bentonite <br /> DZBentonite (from) k6 (to) V2- <br /> Inspector: L),nnn r at L- Grout (from)_ (to) St 6 <br /> Drilling rig type <br /> Permit No. & I l Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: tr'c <br /> Driller: --zz�� casing <br /> height <br /> Consultant <br /> Geologist TOW ECA41--,k• - <br /> ABOVE-GROUND <br /> COMPLETION CHRMY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface 7— <br /> Distance to sewer line <br /> prart <br /> Domestic well on site - (y _tt <br /> If yes, location and ce - <br /> � ft.Z ft. <br /> a <br /> = m <br /> a <br /> _ m <br /> c <br /> SAMPLING ebtted = c <br /> Holding Temperature C-&: Lt <br /> Method 4 '-l,�rN...� . L _ VIVO' <br /> Screening Method Pr V = <br /> Tracking Sheet - n ) <br /> v 2- <br /> SPOILS Ben(onI}t 1 t d <br /> Storage Method SS g�t o(nkt+ MATERIALS/DEVELOPMENT <br /> Contamination Noted - 0/ n ) <br /> Storage Location m. sef2n $o�� Casing type L 1°VC <br /> Blank ft. Screen f0 ft. <br /> Slot size ozo <br /> GROUTING Bags cement <br /> Buckets bentonite / G�efwf <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 />