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`%MONITORING WELL INSTALLATION REPG,, <br /> Date: �/ ' �� ' �� CONSTRUCTION <br /> Premise Address: §,00 IJ to e Sties Total Depth <br /> ' I Screen Length (from) 7• (to)7,J <br /> Well No.: _ V l,� ' Filter Pack (from) (to) J <br /> Bentonite (from) (to) -o- <br /> Inspector: <br /> Inspector: Grout (from) 3- — to) -�— <br /> Drilling rig type Q-f(�-- <br /> Permit No. Auger O.D. /Z, 2'S .D._ _ 7� <br /> Completion - Stove pipclu-istie box (circle one) <br /> Drilling Company:_ <br /> Driller: Oou-(C" t>Uf raw 4 casing <br /> height <br /> Consultant 171 <br /> 4 <br /> Geologist IJP iii� --- <br /> ABOVE-GA LUNO CHRZTY-sox <br /> COMPLET30N COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfacs <br /> Distance to sewer line ty <br /> proof <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - <br /> SAMPLING <br /> sacicn <br /> B <br /> Holding Temperature <br /> Method –'- ack <br /> 9M F <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> M <br /> SPOILS <br /> Storage Method DL- bOA,1 .G MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) 6 <br /> Storage Location (9>✓f S11tr Casing type 4 cs'Cv{10 <br /> Blank 5 ft. Screen 4-0 ft. <br /> Slot size d- 17/O <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water >� Bags sand/gravel <br /> Mix Ratios _ 5� d Filter Pack type/size [�- <br /> Installation Methodr Surge Block: - (y/ n ) T <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />