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MONITORING WELL INSTALLATION REPO{nt"Io'� <br /> Date: �Lt� L 3(�,/ OQ CONSTRUCTION (1� <br /> Premise Address:_�C)i) / Total Depth <br /> I��j��/�/i/� Screen Length (from) (to) <br /> Well No.: 7�� Y Filter Pack (from) (to) Z <br /> Bentonite (from) 2 (to) <br /> Inspector: Grout (from) (to) b <br /> Drilling rig type gS <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> 1 <br /> Driller: J casing <br /> height <br /> Consultant / <br /> Geologist <br /> ABOVEGROUND ,\ , <br /> COMPLETION O ON <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line ? grout <br /> Domestic well on site - (y n 1q <br /> If yes, location and distance - ft. <br /> gp n. <br /> n. - <br /> = m <br /> — o <br /> _ <br /> SAMPLING9dotted — <br /> . <br /> Holding Temperatures (i _ ��pack <br /> Method ��� <br /> Screening Method <br /> Tracking Sheet ( y ) 8 <br /> SPOILS <br /> Storage Method -')59a A44-/-� � MATERIALS/DEVELOPMENT <br /> Contamination Noted - (yy 1 nrt <br /> Storage Location Ot/fit Casing type 2 <br /> Blank 19c, ft. Screen S ft. <br /> lot size <br /> GROUTING *Bags cement G + <br /> Buckets bentonite L �fL• 30 <br /> Depth to water = Bags sand/gravel 2Q <br /> Mix Ratios -3k wFilter Pack type/size <br /> Installation Method s--t o0i-7_0 Surge Block: - (y/ n ) <br /> Quantity Installed .50--50-t Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br /> k'�� Al �' / . �"' <br />