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MONITORING WELL INSTALLATION RE. J <br /> Date: f 3� - �� t�t� �� 4-5�07 CONSTRUCTION <br /> )Premise Address:/ 7 7 �L �{� Total Depth tis C'-+ <br /> Screen Length (from) o) �G <br /> Well No.: "1 Filter Pack (from) (to)q_ <br /> 1 � Bentonite (from) 3U (to) <br /> Inspector: F` Grout (from) <br /> Drilling rig type !"� <br /> Permit No.Oi lq�j Auger_O.D,_ / 3 I.D. <br /> >, Completion--Stove pipe/christie box (circle one) <br /> Drilling Company: ( l G <br /> Driller: casing <br /> /- <br /> height <br /> Consultant t'-t � <br /> ' � alp <br /> —QW—f <br /> Geologist ABOVE-GROUND <br /> COMPLETION CHRISTY-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) �7,d n. <br /> If yes, location and distance - ,S ft• <br /> -- fit• — Tfu� cu..a z <br /> _ <br /> — o <br /> SAMPLING slonad <br /> a*don <br /> Holding Temperature = gravelPack <br /> Method = <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) <br /> SPOILS ri <br /> Storage Method MATERIALS/DEVEEOPMENT 6 <br /> Contamination Noted - (y/ n ) j S <br /> Storage Location Casing type <br /> Blank Sit, ft. Screen ft. <br /> Slot size /9.4,�- <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water s iG Bags sand/gravel i� <br /> Mix Ratios e,-,4' E'i Filter Pack type/size <br /> Installation Method i4i--' Surge Block: - (y/ n ) <br /> Quantity Installed < t-i Discussed with geologist: - (y/n ) <br /> Type of method <br /> EH 29 29 <br />