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MONITORING WELL INSTALLATION REPT.. - <br /> Date: Z�^�// CONSTRUCTION <br /> Premise Address:/' r''�'r^'-� � Total Depth k( L. <br /> Screen Length (from) C (to) i <br /> J S <br /> Well No.: i (/J wd Filter Pack (from) N 0 (to) <br /> Bentonite (from) C-4 i (to) 1,2 "7 <br /> Inspector: �°� ' ` Grout (from) 1.z`l (to) �u , <br /> Drilling rig type 11U—AL=E" L <br /> Permit No. Auger O.D. I. <br /> b. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> 7//,l -WW-F <br /> Geologist •� <br /> ABOVE-GROUND CHSZ Y43OX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surtact <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - � <br /> ift. ft. <br /> c <br /> SAMPLINGslotted <br /> = o <br /> � <br /> sacron � <br /> Holding Temperature gra„ol pack <br /> Method <br /> Screening Method r` <br /> Tracking Sheet - ( y/ n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) -C u <br /> Storage Location Casing type 7J <br /> Blank t ft. Screen <br /> Slot size (1, <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water t>L 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 />