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`..,MONITORING WELL INSTALLATION REPC--/ <br /> Date: //_,` ` CONSTRUCTION <br /> f _ r <br /> Premise Address: �� l� l l � Total Depth (�I <br /> Screen Length (from)_ ✓� (to) <br /> �! 7 Filter Pack (from) (to) C' <br /> Well No.: _ Bentonite (from) 6,`; (to) <br /> Inspector: G �t � Grout (from) � (to) <br /> Drilling rig type_ A of - <br /> Auger O.D. I.D ZS <br /> Permit No. ircle <br /> one) <br /> Drilling Company: Completion - Stove pip tx <br /> Driller: LZL� �l� I casing <br /> 61 IFM ,The_ght <br /> Consultant �'��- -owl <br /> Geologist Dots 7//, <br /> /1g0VE-G1R0UNO <br /> COMPLE7fON Ci�Fis57Y-80X <br /> COMPLEnON <br /> SPECIAL PERMIT INFO. Ground Sumacs —+ <br /> pram <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) _.,ft. <br /> If yes, location and distance - ft. <br /> -ft. <br /> a:. d <br /> SAMPLING dorad _ <br /> J socicn <br /> r <br /> Holding Temperature, <br /> Method F� <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> ft. — ft. <br /> SPOILS <br /> Storage Method %'� /�� MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) _ & <br /> Storage Location 0&) % �7 Casing type 4 <br /> Blank '7 ft. Screen Gia ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water �� Bags sand/gravel <br /> Mix Ratios Filter Pack type/sized ��--- <br /> Installation MethodSurge Block: - (y/ n ) / <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />