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.ONITORING WELL INSTALLATION REP( <br /> Date: d/ I ISI CONSTRUCTION <br /> i <br /> Premise Address: tL-72 P2�' Total Depth ✓�� <br /> (� Screen Length (from) /% (to) /, S <br /> Well No.: �W`�7 J Filter Pack (from) (to) <br /> Bentonite (from) /ls'% (to) <br /> Inspector: <� Grout (from)�Li _(to 61._, <br /> V, <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant rhlr�&/<' <br /> 7//,l <br /> Geologist •- <br /> ABOVE-GROUND C_SZTY_8OX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Suafacs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> ft. <br /> If yes, location and distance - <br /> ft. <br /> ft. <br /> = m <br /> _ o <br /> SAMPLING dotted <br /> sac�an <br /> Holding Temperature = �,VW Pack <br /> Method — <br /> Screening Method = <br /> Tracking Sheet - ( y/ n <br /> ft. = ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type 1� <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <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 />