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MONITORING WELL INSTALLATION RE�.T <br /> Date: CONSTRUCTION <br /> Premise Address: 111 N�l� Total Depth <br /> Screen Length (from) 1#0 (to) <br /> Well No.: Filter Pack (from) In o (to) 3 <br /> Bentonite (from) 3a (to) 75 C,- <br /> Inspector: <br /> oInspector: ����/ <br /> Grout (from) '15ro (to) I <br /> Drilling rig type C.I.I. 1S <br /> Permit No. OlQ 7j Auger O.D. 1 b'r I.D. <br /> Completion - Stove pie?pisne (circle one) <br /> Drilling Company: <br /> Driller: QnIQ \InOjy�A casing <br /> 11 ` height <br /> Consultant,\ <br /> Geologist -wo AKVA 1 - T <br /> ABOVE-GROUND Ct4i15fY BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. end SuAxs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) ft <br /> If yes, location and distance - ft <br /> fto <br /> — a <br /> = e <br /> = e <br /> — o <br /> SAMPLING slotted _ 8 <br /> ( sec5on <br /> YU� <br /> Holding Temperature <br /> Method = <br /> Screening Method Atli 111 — <br /> Tracking Sheet - (}(�/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (� / n ) I I <br /> Storage Location � (�t>f p 1 Casing type L <br /> Blank? fr Scree fr. <br /> Slot size 0 t0`� <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags Epj/gravel <br /> Mix Ratios Filter Pack type/size 1 C, <br /> Installation Method Surge Block: -S y&D <br /> Quantity Installed Discussed with geologist�: � n) <br /> Type of method pl,r5i, 1 �I <br /> EH 29 29 <br />