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)NITORING WELL INSTALLATION REPf' <br /> 0 1 <br /> Date: U GONSTRUC ION <br /> Premise Address: 62 2 Total Depth <br /> S8 Screen Length'(from) (to) <br /> Well No.: Filter Pack (from)—d 'S ' (to) g <br /> / I Bentonite (from) (to) <br /> 4 --- <br /> Inspector: Grout (from) 8' (to)a <br /> Drilling rig type HS <br /> Permit No. Auger O.D. " d I.D. <br /> Completion -Stove pipe,/christie box teircle one) <br /> Drilling Company <br /> Driller: l C'���C eaa ing <br /> height <br /> Consultant �- <br /> r ` <br /> Geologist jr--\ Ce S <br /> ABOVE-GROUND cp=ore' <br /> ' <br /> COMPLETION <br /> SPECIAL PERMIT INFO. C) G=*d Surf actV/1 grout <br /> Distance to sewer line <br /> Domestic well on site - (y/n Oz 11 ft. <br /> If yes, location and distance - 40 q R. <br /> lip. 47 , <br /> 5AMPLTNG rlanad - <br /> - - radion , <br /> Holding Temperature �; —_ pry,voi papack <br /> Method `°'' —_ <br /> Screening Method . — <br /> Tracking Sheet - (y/z ) <br /> SPOILS <br /> Storage Method MATERIALS/DMLQPMEW <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing LYP� `R�� C <br /> Blank I Q ft. Screen ft, <br /> Slot size-,A _ <br /> GROUTING Bags cement <br /> Buckets beintonite f* e S <br /> Depth to water gags sand/gravel D <br /> Mix Ratios --- Filter Pack type/' e .3 <br /> Installation Method Surge Block: . y Y n) <br /> Quantity installed• Discussed with ologist: - n ) <br /> Tyne of method <br /> EH 29 29 <br />