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',"ONITORING WELL INSTALLATION REPO,,,, <br /> f <br /> Date: L f`t 'C�I _ CONSTRUCTION <br /> Premise Address: MOO r\f wT Total Depth S <br /> Screen Length (from) ('0 (to) <br /> Well No.: �� _ Filter Pack (from) 4Z (to)�_ <br /> Bentonite (from) (to) 2 <br /> Inspector: �✓ � Grout (from) 2. (to) -E:-- <br /> Drilling rig type 1 <br /> Permit No. �' Li870 Auger O.D. 9.2 I.D. /0.2 <br /> Completion -Stove pipe/christie box (circle one) <br /> Drilling Company: ��1�'ls' ,l <br /> Driller: (r (� �Ut(I casing <br /> height <br /> Consultant <br /> 7//, T <br /> Geologist <br /> ABOVE-GRCUND CHS* Y-8OX <br /> COM?LETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfacs �- <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) <br /> ft. <br /> If yes, location and distance - <br /> �. ft. <br /> SAMPLING slora.i = <br /> soden — <br /> Holding TemperatureVIVVI <br /> Method F <br /> Screening Method MO <br /> Tracking Sheet - (y/ n ) <br /> ft. = M <br /> SPOILS <br /> Storage Method Da 1b.4w cj MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) 6 <br /> Storage Location Casing type Y Ism GNU PUC, <br /> Blank !o ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite / &Oc-� <br /> Depth to water Aj /k _ Bags sand/gravel <br /> Mix Ratios ;, ,1<tJtiS Filter Pack type/size <br /> Installation MethodSurge Block: - (y� <br /> Quantity Installed Discussed with geo16-9-ist: - ( y/(!a:y <br /> Type of method <br /> EH 29 29 <br />